^^^^^MBMH^HHBBMMBI 
ty  of  California 
ern  Regional 
ary  Facility 


I 


THE  MAJOR  SYMPTOMS 
OF  HYSTERIA 


FIFTEEN   LECTURES    GIVEN    IN   THE 

MEDICAL   SCHOOL   OF   HARVARD 

UNIVERSITY 


BY 
PIERRE   JANET,    PH.D.,    M.D. 


SECOND  EDITION 
WITH  NEW  MATTER 


THE   MACMILLAN   COMPANY 
1920 

All  rifhtt  reserved, 


COPYRIGHT,  1907  AND  1920, 
BY  THE  MACMILLAN  COMPANY. 


Set  up  and  electrotyped.     Published  June,  1907. 
Second  Edition  Published,  November,  1920. 


NortaooU 

J.  8.  Cashing  Co.  —  Berwick  &  Smith  Co. 
Norwood,  Mass.,  U.S.A. 


PROFESSOR  JAMES  JACKSON  PUTNAM 

OF  HARVARD  UNIVERSITY 

THESE    LECTURES   ARE  AFFECTIONATELY 
DEDICATED 


PREFATORY   NOTE 

ON  the  occasion  of  the  inauguration  of  the  new 
and  magnificent  buildings  of  the  Medical  School  of 
Harvard  University  in  Boston,  President  Eliot  and 
Dr.  J.  J.  Putnam,  professor  of  the  diseases  of  the 
nervous  system,  asked  me  to  deliver  before  the  stu- 
dents some  lectures  about  pathological  psychology. 
I  greatly  appreciated  this  honour,  and  tried  to  sum 
up  before  the  American  students  some  elementary 
psychological  researches  about  a  well-known  disease, 
Hysteria,  in  order  to  show  them  how  the  study  of  the 
mental  state  of  the  patient  can  sometimes  be  useful 
to  explain  many  disturbances  and  to  give  some  unity 
to  apparently  discordant  symptoms.  So  the  follow- 
ing fifteen  lectures  were  given  in  the  Harvard  Medi- 
cal School  between  the  fifteenth  of  October  and  the 
end  of  November,  1906.  Some  of  these  lectures 
were  also  delivered  in  Johns  Hopkins  University  at 
Baltimore,  at  the  request  of  Professor  J.  M.  Baldwin, 
and  in  the  medical  school  of  Columbia  University  in 
New  York,  at  that  of  Professor  Allen  Starr.  I  avail 
myself  of  the  opportunity  of  this  publication  to  offer 
my  best  thanks  to  these  professors  and  their  col- 
leagues for  their  invitation  and  hearty  welcome. 
Let  me,  too,  thank  here  my  friend  M.  Edouard 
Philippi,  for  the  very  useful  help  he  gave  me  in 
drawing  up  these  lectures  in  a  foreign  language. 


CONTENTS 


PAGE 

PREFATORY  NOTE vii 


LECTURE  I 
THE  PROBLEM  OF  HYSTERIA    . 


LECTURE   II 
MONOIDEIC  SOMNAMBULISMS 22 

LECTURE  III 

FUGUES   AND   POLYIDEIC    SOMNAMBULISMS  ...        44 

LECTURE  IV 
DOUBLE  PERSONALITIES 66 

LECTURE  V 

CONVULSIVE    ATTACKS,    FITS    OF    SLEEP,    ARTIFICIAL 

SOMNAMBULISMS 93 

LECTURE  VI 

MOTOR  AGITATIONS  —  CONTRACTURES     .        .        .        .117 

i 

LECTURE  VII 

PARALYSES  —  DIAGNOSIS 138 

ix 


x  Contents 

LECTURE   VIII 

PAGE 

THE  PSYCHOLOGICAL  CONCEPTION  OF  PARALYSES  AND 

ANESTHESIAS .        .159 

LECTURE  IX 
THE  TROUBLES  OF  VISION       .       .       .       .       .       .182 

LECTURE  X 
THE  TROUBLES  OF  SPEECH 208 

LECTURE  XI 
THE  DISTURBANCES  OF  ALIMENTATION   ....    227 

LECTURE  XII 
THE  Tics  OF  RESPIRATION  AND  ALIMENTATION     .        .    245 

LECTURE  XIII 
THE  HYSTERICAL  STIGMATA  —  SUGGESTIBILITY      .       .    270 

LECTURE  XIV 

THE  HYSTERICAL  STIGMATA  — THE  CONTRACTION  OF 
THE  FIELD  OF  CONSCIOUSNESS  —  THE  COMMON  STIG- 
MATA   293 

LECTURE  XV 
GENERAL  DEFINITIONS 317 

INDEX .    339 


INTRODUCTION    TO    THE    SECOND 
EDITION 

THE  kind  reception  these  lectures  on  hysteria  have 
met  with  encourages  us  to  publish  a  second  edition 
of  this  work.  It  does  not  seem  to  us  very  useful  to 
modify  it  profoundly,  for  the  interest  of  a  scientific 
work  resides  almost  always  in  the  date  a't  which  it 
was  drawn  up,  and  one  should  not  confusedly  mix 
the  ideas  of  one  period  with  those  of  another.  I  only 
wish  to  show  in  a  short  preface  that  certain  notions 
set  forth  in  these  lectures  of  1906  have  spread  very 
much  since  that  date  and  have  played  a  great  part  in 
the  interpretation  of  hysteria.  I  should  also  like  to 
show  in  what  direction  I  have  been  led  myself,  in 
my  other  works  published  since  that  time,  to  develop 
certain  of  my  preceding  interpretations. 

One  of  the  chief  conceptions  that  have  directed  my 
first  researches  on  hysteria  is  that  of  the  importance 
of  fixed  ideas  in  this  disease :  many  of  the  most  appar- 
ent symptoms  recognized  in  the  attacks,  the  somnam- 
bulisms, the  disturbances  of  motility  and  sensibility, 
are  but  an  outer  manifestation,  an  expression  of  a 
conviction  the  patient  keeps  in  his  mind.  In  one  of 
my  first  works  on  hysteria,  published  in  I892,1  I 
classed  all  these  various  accidents,  the  paralyses,  con- 
tractures,  dysaesthesias,  etc.,  in  the  chapter  on  "  fixed 

1  L'ttat  mental  des  hysUriques,  1892,  II,  p.  56;  2d  ed.,  F.  Alcan, 
1911,  p.  239. 

ri 


xii  Introduction 

ideas."  It  is  equally  this  interpretation  that  takes 
up  the  greatest  place  in  these  lectures  on  "The  Major 
Symptoms  of  Hysteria." 

It  is  not  without  interest  to  remark  that  this  con- 
ception has  become  the  starting-point  of  the  now  most 
widespread  theories  which,  under  the  name  of  "pithia- 
tism,"  sum  up  the  whole  hysterical  disease  by  that 
disposition  to  auto-suggestion  which,  according  to 
them,  is  capable  of  transforming  the  ideas  of  the  sub- 
ject into  real  accidents.  In  these  theories,  the  hyster- 
ical phenomena  have  the  great  character,  common  to 
all  of  them  and  existing  only  in  them,  that  they  are 
the  result  of  the  very  idea  the  patient  has  of  his 
accident:  "the  hysteric  patient,"  M.  Bernheim  al- 
ready said,  "  realizes  her  accident  as  she  conceives  it." 
This  view  is  really  interesting  and  has  surely  some 
preciseness,  for  there  is  not  any  organic  disease  nor 
even  any  other  mental  disease  in  which  matters  go 
in  this  way.  Nobody  will  maintain  that  in  a  maniacal 
fit  the  patient  is  agitated  because  he  is  thinking  of 
agitation.  This  development  of  the  accidents  by  a 
mechanism  always  identical  to  that  of  suggestion 
would  therefore  be  something  peculiar  to  hysteria 
and  could  evidently  serve  to  define  it. 

Far  from  contradicting  the  pithiatic  interpretation 
of  hysteria,  which  in  my  first  writings  I  had  already 
proposed  to  apply  to  many  of  the  symptoms  of  the 
neurosis,  I  should  now  be  inclined  to  believe  that  it 
ought  to  be  still  extended.  One  of  the  characters  of 
the  present  conception  of  hysteria  depends  on  the 
milieu  in  which  it  has  been  particularly  studied,  I 


Introduction  xiii 

mean  the  Clinic  of  the  Salpetriere.  This  Clinic  was 
much  more  neurologic  than  psychiatric,  and  was 
chiefly  devoted  to  the  study  of  the  somatic  accidents, 
of  the  paralyses,  the  contractures  depending  on 
diseases  of  the  nervous  system.  This  is  what  has 
determined  the  direction  of  the  studies  on  hysteria : 
what  has  been  considered  by  preference  in  this  disease 
is  the  paralyses,  the  contractures,  the  disturbances 
of  the  elementary  sensibilities,  as  if  these  accidents 
constituted  the  essential  of  the  neurosis.  But  if 
at  the  present  time  we  agree  that  hysteria  is  before 
everything  else  a  mental  disease  consisting  chiefly 
in  an  exaggeration  of  suggestibility,  we  shall  have  to 
connect  more  and  more  with  it  accidents  properly 
mental  in  which  this  exaggeration  is  also  manifested, 
impairments  of  the  memory,  fixed  ideas  without 
somatic  manifestations,  and  even  deliriums  in  which 
auto-suggestion  equally  plays  an  evident  role.  The 
old  hysteric  deliriums  are  nearly  forgotten  now; 
it  will  perhaps  be  well  to  restore  them,  calling  them, 
if  one  pleases,  pithiatic  deliriums :  it  will  enable  us 
better  to  understand  a  certain  number  of  rather  badly 
interpreted  mental  disturbances. 

It  is  none  the  less  true  that  this  conception  of  the 
hysterical  neurosis  is  far  from  complete,  and  the  re- 
strictions already  laid  on  them  in  these  lectures 
(p.  326)  seem  to  me  to  have  kept  all  their  importance. 
I  had  occasion  to  insist  upon  this  discussion  in  my 
little  book  on  "Les  nevroses"  (Flammarion,  1909, 
P-  325))  which,  I  hope,  will  soon  be  translated  into 
English.  To  be  able  to  explain  a  symptom  by  auto- 


xiv  Introduction 

suggestion,  one  must  be  able  to  demonstrate  that  the 
idea  of  this  symptom  has  been  predominant  in  the 
mind  of  the  subject  before  the  appearance  of  the 
symptom,  that  the  idea  has  been  automatically  trans- 
formed into  a  belief,  and  that  this  belief  has  played 
a  part  in  the  development  of  the  symptom.  Now  it 
is  easy  to  show  that  such  a  demonstration  has  not 
been  made  and  cannot  be  made  in  every  case.  The 
fundamental  psychological  characters  of  the  neurosis, 
the  disappearance  of  the  activities  of  the  higher  order, 
the  laziness  of  the  mind,  the  disposition  to  absent- 
mindedness,  the  contraction  of  consciousness  and  the 
suggestibility  itself  cannot  be  considered  as  phenomena 
of  pithiatism.  No  doubt  a  great  share  must  be  given 
to  suggestion,  but  it  should  not  be  forgotten  that  in 
a  normal  mind  suggestion  does  not  give  rise  to  serious 
accidents,  and  it  is  necessary  to  explain  on  what  de- 
pends its  power,  abnormal  in  certain  minds,  for  it  is 
that  which  characterizes  the  hysterical  malady. 

In  my  early  writings  and  in  these  lectures  on  "The 
Major  Symptoms  of  Hysteria,"  there  was  another 
notion  to  which  I  gave  an  important  r61e  to  play,  the 
notion  of  the  contraction  of  the  field  of  consciousness 
and  that  of  subconscious  psychological  phenomena. 
I  showed  in  these  lectures  that  one  of  the  chief 
characters  of  hysterical  anesthesias,  distractions, 
amnesias,  paralyses  was  not  the  disappearance  of  a 
psychological  phenomenon,  but  a  particular  trans- 
formation of  this  phenomenon  in  consciousness.  It 
ceased  to  be  a  part  of  personal  consciousness  and  no 
longer  existed  but  in  another  grouping  of  psychological 


Introduction  xv 

phenomena  which  constituted  the  sub-consciousness 
or  sometimes  the  second  consciousness  of  the  somnam- 
bulisms or  of  the  medianimic  writings. 

These  new  notions  have  also  had  a  remarkable 
development  in  the  theories  that  have  tried  to  ex- 
plain the  hysteric  neurosis  through  conversion,  sym- 
bolism, "driving  back."  Certain  ideas,  certain  recol- 
lections present  themselves  to  the  mind  of  the  sub- 
ject in  a  painful  manner,  for  they  hurt  his  sensibility 
and  are  in  opposition  with  his  moral  feelings.  Dis- 
satisfied with  having  such  thoughts  in  his  mind,  the 
subject  makes  great  efforts  to  get  rid  of  them:  he 
struggles  in  every  way  with  these  ideas,  and  when 
they  present  themselves  to  his  consciousness,  he 
stops  them,  he  does  not  allow  them  to  develop,  to 
realize  themselves  in  acts  and  clear  thoughts,  and 
endeavours  not  to  notice  them,  to  forget  them.  "Driv- 
ing back,"  it  was  said,  forms  a  part  of  the  systems 
of  defence  of  the  organism.  The  ideas  thus  driven 
back  became  the  subconscious  phenomena  and  brought 
about  in  this  manner  various  pathological  disturb- 
ances. 

In  my  last  work,  "Les  medications  psychologiques" 
(F.  Alcan,  1919,  Vol.  II,  pp.  256-262),  I  had  occasion 
to  study  these  theories  of  driving  back,  to  show  their 
importance  and  their  relations  to  the  early  writings 
on  subconscious  phenomena.  In  that  work  I  ex- 
amined a  remarkable  case  of  left  hysterical  hemiplegy, 
in  which,  after  a  tragical  event  relative  to  his  left  side, 
the  subject  evinced  singular  horror  for  this  side; 
the  driving  back,  which  seemed  here  obvious,  could 


xvi  Introduction 

be  regarded  as  the  determinative  cause  of  the  hemi- 
plegy  itself.  I  tried  to  show  likewise  that  phe- 
nomena analogous  to  driving  back  can  play  an  in- 
teresting part  in  the  formation  of  certain  impulsions, 
of  certain  obsessions,  particularly  in  the  monstrous 
and  sacrilegious  obsessions.  These  new  studies 
seemed  therefore  to  continue  the  preceding  ones  in 
the  same  direction  and  sometimes  to  complete  them 
in  a  useful  manner. 

Nevertheless,  as  the  theories  of  pithiatism  seem  to 
me  insufficient,  so,  and  wiih  still  stronger  reason,  I 
consider  the  theories  of  "driving  back"  as  incapable 
of  giving  a  complete  explanation  of  the  hysterical 
neurosis.  The  facts  that  are  interpreted  in  this  way 
can  often  be  understood  in  another  manner.  With 
regard  to  the  case  of  hemiplegy  to  which  I  have  just 
referred,  I  have  shown  that  the  horror  of  the  subject 
for  his  left  side  could  very  well  be  considered  as  the 
consequence  of  the  incipient  paralysis  instead  of  being 
its  starting-point.  But  the  most  important  problem 
concerns  driving  back  itself,  as  a  moment  ago  it 
concerned  suggestion.  With  normal  individuals,  the 
regret,  the  scorn  for  certain  ideas,  the  driving  back  is 
far  from  bringing  on  analogous  pathologic  disturbances. 
To  produce  such  results,  the  driving  back  must  al- 
ready be  exaggerated  and  transformed  by  the  disease. 
Driving  back,  such  as  it  is  presented  in  these  theories, 
seems  to  me  to  be  a  symptom  of  the  malady,  as  sug- 
gestion did  before,  and  it  requires  itself  an  explanation. 

To  get  beyond  these  first  interpretations,  to  make 
new  progress  in  these  studies  of  psycho-pathology,  it 


Introduction  xvii 

would  be  useful  to  analyze  more  thoroughly  these 
symptoms,  which  are  too  readily  taken  as  starting- 
points,  and  with  which  one  tries  to  link  all  the  other 
phenomena  without  explaining  them  themselves.  It 
would  be  necessary,  if  I  mistake  not,  better  to  under- 
stand the  nature  of  these  phenomena  of  suggestion, 
of  subconsciousness,  of  driving  back,  and  the  condi- 
tions that  bring  about  their  exaggerated  develop- 
ment. This  is  why  in  my  last  writings,  which  at- 
tempt to  complete  these  lectures  on  hysteria,  I 
have  begun  again  the  analysis  and  the  interpretation 
of  the  psychological  phenomenon  of  impulsion,  which 
seems  to  me  to  constitute  the  essential  part  of  all 
the  preceding  facts. 

The  question  here  is  of  the  problem  of  voluntary 
action  with  individuals  capable  of  conceiving  the  idea 
of  an  action  before  executing  it,  and  capable  of  con- 
necting in  various  ways  the  idea  of  the  action  with  the 
action  itself,  that  is  to  say  with  the  motion  of  their 
limbs;  in  a  word,  the  question  is  of  the  problem  of 
ideo-motor  activity.  Will  and  belief,  which  are  the 
two  forms  of  this  activity,  are  analogous  mental 
operations :  in  will,  the  execution  of  the  act  is  im- 
mediate, as  soon  as  the  idea  is  accepted,  the  act  is 
realized  by  the  motion  of  our  limbs;  in  belief,  the 
question  is  also  of  the  execution  of  an  act,  but  the 
conditions  of  this  act  not  being  immediately  present, 
the  question  is  of  a  deferred  and  conditional  act.  To 
believe  that  it  is  raining  outside  is  to  make  up  one's 
mind  to  open  one's  umbrella  if  one  goes  out,  but 
is  not  to  open  it  immediately  in  the  room.  In 


xviii  Introduction 

both  these  forms  of  action,  the  essential  is  the  estab- 
lishment of  a  connection  between  the  idea  of  the  act 
and  the  act  itself,  either  immediate  or  deferred,  it  is  the 
operation  of  assent. 

With  normally  evolved  and  healthy  individuals, 
this  assent  can  be  performed  in  a  perfected  manner, 
thanks  to  the  mechanism  of  reflection.  The  ideas  of 
different  actions  then  present  themselves  to  the  mind, 
but  they  are  stopped,  suspended  in  their  develop- 
ment, and  are  not  immediately  transformed  into  wills 
or  beliefs.  They  are  compared,  opposed  to  one  an- 
other ;  in  this  comparison,  one  does  not  only  take  into 
account  the  present  momentary  force  of  the  different 
ideas,  each  of  which  is  more  or  less  accompanied  with 
desire.  Reflection  calls  up  moreover  the  still  latent 
force  of  the  tendencies  that  each  idea  represents.  It  is 
only  after  a  longer  or  shorter  deliberation,  in  which 
these  deep  forces  are  appreciated,  that  one  of  these 
ideas  is  adopted  by  assent  and  allowed  to  develop  into 
will  or  belief.  The  wills  or  beliefs  thus  brought  about 
by  reflective  assent  represent  the  real  forces  of  our 
tendencies,  all  of  which  have  been  called  up  and 
weighed ;  they  are  exactly  conformable  to  our  whole 
personality,  they  are  accompanied  in  the  highest  de- 
gree with  the  feelings  of  personality  and  reality. 

Such  assents  are  difficult  and  require  mental  activity 
of  a  high  order.  In  other  circumstances,  they  may  be 
replaced  by  assents  that,  while  apparently  analogous, 
are  brought  on  in  a  simpler  and  easier  way.  Reflec- 
tion does  not  come  in  to  stop  the  ideas,  to  investigate 
the  latent  force  of  the  tendencies  they  represent. 


Introduction  xix 

The  assent  is  immediate,  and  is  simply  induced  by  the 
present  and  momentary  force  that  each  idea  brings 
with  it,  whatever  may  be  the  accidental  circumstance 
which  gives  it  this  force.  Then  it  is  that  one  wills 
and  believes  simply  what  one  desires,  what  pleases 
one  momentarily,  what  is  strongly  presented  to  one's 
mind  by  an  outer  influence.  The  question  is  still 
of  wills  and  beliefs,  but  these  phenomena  are  immedi- 
ate and  irreflective.  They  still  bring  about  acts, 
and  even  acts  that  are  sometimes  more  violent,  and 
more  tenacious,  but  they  do  not  in  the  same  manner 
involve  the  whole  personality  and  do  not  bear  with 
them,  like  reflective  beliefs,  the  feeling  of  reality. 
It  is  such  wills  and  such  beliefs  that  are  often  ac- 
companied with  the  feelings  of  automatism,  deperson- 
alization  and  irreality. 

It  is  easy  to  observe  that  certain  minds  seem  to  be 
fixed  in  one  or  the  other  of  these  modes  of  assent. 
Selfish  minds,  capable  of  well  understanding  personal 
interest  and  of  well  calculating  it,  utilize  almost  ex- 
clusively the  reflective  mode ;  weak  minds,  incapable 
of  resisting  their  momentary  desires,  docile  to  every 
influence,  hardly  get  beyond  the  second.  But  an- 
other psychological  state  is  particularly  interesting, 
namely  that  of  the  minds  that,  according  to  circum- 
stances, oscillate  between  these  two  modes  of  assent. 
Certain  individuals  are  in  reality  capable  of  reflection, 
as  they  are  capable  of  discussing  with  an  adversary 
who  contradicts  their  opinions.  But  they  cannot 
sustain  the  discussion  for  a  long  while.  If  the  ad- 
versary insists  for  some  time,  their  resistance  is  very 


xx  Introduction 

soon  exhausted  and  they  give  up  the  struggle  to  adopt 
the  strange  opinion.  Likewise  they  begin  the  re- 
flection, which  is  a  sort  of  inner  discussion,  then  they 
get  tired,  and,  without  concluding  the  deliberation  they 
have  begun,  they  allow  themselves  to  be  carried  away 
by  some  desire  or  other.  Impulsion  appears  to  me  to 
consist  essentially  in  this  insufficiency  of  reflection, 
which  stops  at  a  more  or  less  advanced  stage  of  its 
evolution  and  is  transformed  into  immediate  assent. 
Suggestion,  obsession,  exaggerated  driving  back  are 
varieties  of  impulsion.  These  phenomena  arise  when 
different  phenomena  bring  about  the  rapid  exhaustion 
of  reflection  and  the  appearance  of  immediate  and 
elementary  assents. 

We  find  here  once  more  the  fundamental  phenom- 
enon which  plays  an  important  part  in  all  the  disturb- 
ances of  the  mind,  the  decay,  the  lowering  of  the  mind, 
which  passes  from  a  form  of  higher  activity  to  a  lower 
form.  This  phenomenon  is  met  with  in  hysteria  as 
well  as  in  all  the  psychoses,  and  the  study  of  hysteria 
should  not  be  separated  from  the  more  general  study 
of  the  psychological  depressions.  The  defect  of  most 
of  the  preceding  writings  is  that  the  early  authors  have 
too  much  considered  hysteria  in  itself,  because  at  the 
outset  of  psycho-pathology  the  study  of  psychological 
phenomena  appeared  particularly  easy  in  this  disease. 
At  the  present  day  we  must  extend  the  studies  in 
psycho-pathology  and  replace  hysteria  in  the  ensemble 
of  the  mental  diseases,  and  in  particular  put  it  in 
its  place  in  the  table  of  the  psychological  depressions, 
of  which  it  presents  us  only  a  particular  case. 


Introduction  xxi 

If  we  attempted  this  study,  which  is  very  difficult 
nowadays,  we  might  say  that  hysterical  patients,  by 
reason  of  their  heredity,  by  the  evolution  of  puberty, 
in  consequence  of  various  intoxications,  various  ex- 
haustions, under  the  influence  of  fatigues,  of  emotions, 
which  are  phenomena  analogous  to  fatigues,  have 
fallen  into  a  very  enduring  but  not  very  deep  depres- 
sion, reaching  the  level  of  mental  laziness.  In  my 
lectures  at  the  College  de  France  on  these  oscillations 
of  the  mind,  I  presented  sadness  as  the  first  degree  of 
depression,  and  laziness  as  the  second.  In  that  state 
of  laziness,  the  patients  are  still  capable  of  reflection, 
which  disappears  only  in  the  third  degree,  that  of 
aboulias,  but  they  are  incapable  of  the  rational  or 
"ergetic"  acts  in  which  the  individual  through  his 
efforts  adds  energy  to  rational  or  experimental  ideas, 
powerless  by  themselves.  At  the  level  of  mental  lazi- 
ness, the  subject  is  passionate,  selfish,  lazy,  and  given 
to  telling  lies,  for  these  are  the  essential  features  that 
psychological  activity  assumes  in  this  form  of  de- 
pression, but  he  has  not  yet  any  characteristic  acci- 
dents. 

Under  different  influences  which  bring  on  greater 
exhaustion,  there  is  from  time  to  time  with  these 
patients  a  period  of  deeper  depression.  The  fall  is 
often  manifested  by  particular  symptoms :  the  con- 
vulsive attacks,  the  crises  of  tears,  the  agitations,  the 
megrims  themselves  are  often  phenomena  of  discharge 
and  relaxation.  The  subject  has  gone  down  one  de- 
gree, he  remains  at  the  level  of  aboulia.  He  has  lost 
the  mental  syntheses  that  constitute  reflective  will 


xxii  Introduction 

and  belief,  he  simply  transforms  into  automatic  wills 
and  beliefs  the  tendencies  which  are  momentarily 
the  strongest.  It  is  at  that  moment  that  the  sugges- 
tions, the  fixed  ideas,  the  deliriums  arise  which  com- 
plicate the  disease  during  longer  or  shorter  periods, 
till  the  subject  reascends  to  the  preceding  level,  that 
of  mental  laziness. 

In  all  the  mental  diseases,  oscillations  of  this  kind 
are  observed  which  bring  about  falls  to  more  or  less 
inferior  levels  and  leave  the  subject  for  a  longer  or 
shorter  time  at  the  level  to  which  he  has  fallen.  The 

hierarchic  table  of  the  various  activities  will  be  es- 
i 

tablished  one  day,  and  such  or  such  a  psychosis  will 
be  determined  by  the  level  to  which  the  depression 
falls  in  the  various  phases  of  this  disease ;  in  a  word, 
this  disease  will  be  determined  by  drawing  the  curve 
of  the  psychologic  depression  in  the  evolution  of  the 
disease,  and  by  showing  that  this  curve  is  characteris- 
tic. In  many  psychoses,  in  confusions,  in  toxic 
deliriums,  in  dementias,  the  curve  descends  very  low, 
as  far  as  the  level  of  elementary  intellectual  activities 
or  of  reflex  activities.  But  we  may  give  the  name  of 
hysteria  to  a  certain  curve  of  mean  depth  which  shows 
frequent  oscillations  between  mental  laziness  and  a 
more  or  less  profound  aboulia.  It  is  these  oscilla- 
tions, these  depressions  to  a  mean  depth  that  account 
for  the  insufficiencies  of  the  mental  synthesis  and  the 
various  impulsions  which  psychologic  analyses  had 
first  shown  us  under  the  apparently  physical  symptoms 
of  hystericals. 
Such  are,  briefly  summed  up,  the  researches  that 


Introduction  xxiii 

in  my  last  works  I  have  tried  to  add  to  the  first 
investigations  presented  in  these  lectures.  I  have 
simply  indicated  them  in  this  preface  to  encourage  the 
readers  to  consider  these  lectures  as  a  starting-point 
and  to  go  beyond  this  old  teaching  through  their  own 
studies. 

PIERRE  JANET 

Paris,  April  10, 1920. 


THE    MAJOR    SYMPTOMS    OF 
HYSTERIA 

LECTURE  I 

THE  PROBLEM  OF  HYSTERIA 

The  interest  and  importance  of  studying  hysteria  —  The 
philosophical  and  the  medical  point  of  view  —  Brief 
account  of  the  evolution  of  the  studies  about  this  disease  — 
The  necessity  for  the  psychological  study  of  the  neuroses  — 
The  psychological  type  of  hysteria 

GENTLEMEN:  President  Eliot  and  the  Professors 
of  the  great  University  of  Harvard  have  determined 
to  celebrate  the  opening  of  the  new  buildings  of  your 
Medical  School  by  putting  into  practice  a  beautiful 
and  great  thought.  They  have  determined  to  invite 
to  come  among  them  foreign  professors,  and  have 
begged  them  to  expose  before  you  the  ideas  and  teach- 
ings they  give  in  other  countries.  It  is  a  mode  of 
teaching  which  is  very  often  used  in  American  uni- 
versities but,  unfortunately,  is  rarely  applied  in  France. 
It  may  have  the  most  beautiful  results  for  the  teaching 
of  youth,  for  the  development  of  science,  and  for  the 
union  of  the  various  nations,  which  is  in  our  time  the 
great  aim  of  all  true  civilizations.  Unhappily  the 
application  of  this  beautiful  method  is  very  difficult, 
for  all  depends  on  the  choice  of  that  foreign  professor 


2          The  Major  Symptoms  of  Hysteria 

called  momentarily  to  teach  among  you.  No  doubt 
I  congratulate  myself  very  much  upon  the  choice 
which  has  been  made;  it  is  for  me  a  great  honour, 
it  gives  me  an  opportunity  to  see  again  a  town  of  which 
I  am  very  fond,  and  to  try  to  diffuse  among  you  some 
ideas  to  which  I  hold.  But  I  dare  not  congratulate  you 
upon  this  choice,  for  I  am  afraid  my  ignorance  of  your 
methods  of  teaching,  and  above  all  my  ignorance  of 
your  tongue,  will  make  these  lectures  very  hard  to 
understand  and  very  painful  to  hear.  First,  I  make 
you  my  apologies;  then,  I  wish  you  may  overcome 
this  bad  luck  and  forget  as  much  as  possible  the  in- 
correctness and  strangeness  of  my  language.  This 
done,  let  us  all  do  our  best  —  you  to  understand  me 
tolerably  well  and  to  draw  from  these  lectures  some 
notions  of  what  interests  French  students;  I,  to  speak 
nearly  intelligible  English  and  to  give  you  as  favourable 
an  impression  as  possible  of  the  psychological  study 
of  nervous  diseases  in  the  French  universities. 


With  the  approval  of  President  Eliot  and  of  Pro- 
fessor James  J.  Putnam,  I  have  chosen  as  the  subject 
of  these  lectures  the  study  of  that  nervous  and  mental 
disease  called  Hysteria.  The  reason  of  this  choice 
is  that  from  many  points  of  view  this  study  seems 
to  me  pretty  well  to  answer  the  wish  of  the  professors 
who  called  me.  When  a  foreign  professor  is  asked 
to  express  his  ideas  in  another  country,  he  is  expected 
to  expose  one  of  the  most  characteristic  studies  of  his 


The  Problem  of  Hysteria  3 

native  land,  just  as,  when  we  have  landed  in  a  new 
country,  we  seek  to  taste  the  dishes  that  characterize 
its  cookery.  Well,  it  seems  to  me  that  what  has  been 
most  characteristic  in  France  for  a  score  of  years  in 
the  study  of  nervous  diseases  is  the  development  of 
pathological  psychology.  No  doubt,  the  clinic  and 
anatomic  study  of  these  same  diseases  is  very  honour- 
ably represented  by  French  names,  but  this  study  has 
developed  in  the  same  way  in  other  countries,  and  I 
think  you  have  not  much  for  which  to  envy  us  in  this 
matter.  Psychological  studies,  properly  so  called, 
especially  the  studies  of  psychological  measures,  have 
developed  in  Germany  and  in  America  more  than  in 
France,  and  it  is  not  here,  near  Professor  Miinster- 
berg's  laboratory,  that  it  would  be  well  to  come  and 
deliver  a  lecture  on  this  subject.  But  it  seems  to  me 
that  in  France,  under  the  influence  of  two  of  my  masters, 
whose  names  I  like  to  recall,  —  Charcot  and  Professor 
Ribot,  —  was  realized  an  interesting  union  between 
two  studies  which  were  for  the  most  part  separated 
before.  Beautiful  natural  experiences  have  been  bor- 
rowed from  mental  pathology  which  strongly  illumi- 
nate the  problems  of  psychology;  on  the  other  hand, 
notions  of  experimental  psychology  have  been  made 
use  of  in  order  to  understand  and  sometimes  to  treat 
patients'  mental  disturbances.  I  should  be  happy  to 
make  you  feel  how  interesting  is  this  new  study,  which 
seems  to  me  to  have  very  good  prospects. 

Among  these  studies  of  pathological  psychology, 
I  determined  on  taking  that  of  a  particular  nervous 
disease,  Hysteria;  I  think  it  is  by  this  one  that  one 


4          The  Major  Symptoms  of  Hysteria 

should  begin  nowadays;  for  this  we  have  historical 
and  scientific  reasons.  Look  back  to  the  time  of  the 
first  works  of  Charcot,  Ribot,  and  their  pupils.  Cast 
a  glance  at  the  innumerable  works  which,  twenty  years 
ago,  determined  that  current  of  researches.  Remem- 
ber the  names  of  Mesnet,  Pitres,  Paul  Richer,  Charles 
Richet,  Binet,  Fe're',  Marie,  Grasset,  Gilles  de  la 
Tourette,  Brissaud,  and  in  foreign  countries,  of  Del- 
boeuf,  Moebius,  Breuer,  Freud,  Morton  Prince, 
etc.  Remark  what  was,  by  a  kind  of  singular  common 
understanding,  the  subject  of  all  their  works.  No 
doubt  they  seemed,  like  Professor  Ribot,  to  speak  of  all 
possible  mental  diseases  and  to  seek  for  mental  dis- 
turbances in  all  the  forms  in  which  they  present  them- 
selves. Now  and  then,  it  is  true,  they  devoted  a  few 
lines  to  idiocy  or  insanity ;  but  if  you  read  their  books 
again,  you  will  see  that,  whatever  the  matter  is,  "  Mala- 
dies de  la  Me"moire,"  "Maladies  de  la  Volonte*," 
"Maladies  de  la  Personnalite","  they  always  speak 
of  localized  amnesias,  of  alternating  memory,  which 
in  reality  are  only  to  be  met  among  hysterical  som- 
nambulisms ;  of  irresistible  suggestions,  hypnotic  cata- 
lepsias,  which  are,  as  I  will  try  to  prove  to  you,  noth- 
ing but  hysterical  phenomena;  of  total  modifications 
of  the  personality  divided  into  two  successive  or  simul- 
taneous persons,  which  is  again  the  dissociation  of 
consciousness  in  the  hysteric.  Besides  all  these  works, 
pathologic  psychology  owes  very  much  to  the  con- 
siderable movement  concerning  hypnotism,  which 
took  place  during  a  few  years.  It  is  certain  that  the 
works  of  Charcot,  Bernheim,  Forel,  and  so  many  others 


The  Problem  of  Hysteria  5 

had  the  greatest  influence  on  the  development  of  this 
new  science,  but  now  that  the  quarrels  of  other  times 
are  somewhat  appeased,  everybody  will  probably 
recognize  a  fact  which  I  hope  also  to  be  able  to  prove 
to  you ;  namely,  that  in  reality  it  is  only  among  hys- 
terical patients  that  this  hypnotism  is  to  be  found  in 
any  marked  degree.  I  will  not  raise  now  the  difficult 
problem  of  deciding  whether  all  the  people  who  can 
be  hypnotised  must  be  called  hystericals,  but  I  believe 
almost  every  good  observer  will  agree  with  me  that  the 
best  studies  about  the  clearest  cases  of  artificially  in- 
duced somnambulism  and  about  its  psychological  proper- 
ties were  made  on  hysterical  subjects.  Consider  even 
the  somewhat  adventurous  authors  who  have  sought  to 
draw  attention  to  particularly  strange  phenomena  and 
who,  by  the  curiosity  they  have  raised,  have  had  a 
share  in  the  development  of  the  same  researches; 
remember  the  studies  on  psychic  polarization,  on  trans- 
fer, on  marked  points  suggestions  (suggestions  a  points 
de  rep&re),  on  unconscious  acts,  etc.  These  studies 
have  always  had  for  their  starting-point  hysteric  phe- 
nomena as  equivalences  and  anesthesias.  In  a  word, 
if  any  interest  is  given  to  the  development  of  that  patho- 
logical psychology  which  has  been  growing  these  twenty 
years,  it  ought  to  be  recognized  that  this  interest  has 
for  its  object  a  special  disease :  Hysteria. 

No  doubt,  such  exclusive  fondness  for  this  study  was 
rather  exaggerated,  and  all  the  psychologists  who,  for 
some  time,  in  imitation  of  the  masters,  studied  the 
hysteric,  were  somewhat  like  the  sheep  of  our  Panurge. 
It  was  an  exaggeration  to  think  that  pathological  psy- 


6          The  Major  Symptoms  of  Hysteria 

chology  could  not  be  studied  on  other  patients.  Dr. 
Fe*r£  was  somewhat  mistaken  when  he  called  hystericals 
the  frogs  of  experimental  psychology.  As  in  physiology 
the  frog  is  not  an  absolutely  necessary  animal  for  our 
experiments,  so  the  hysteric  patient  is  not  the  only  one 
worthy  of  psychological  researches.  We  are  even  cer- 
tain to-day  that  the  hysteric  offer  many  drawbacks, 
and  many  studies  have  been  made  on  other  diseases. 
However,  it  is  true  that  there  were  certain  practical 
reasons  justifying  this  choice  at  the  beginning  of  this 
kind  of  studies;  and  these  practical  reasons  are  still 
the  same  for  you.  The  psychology  of  the  hysteric 
patient,  though  full  of  difficulties  and  obscurities,  is 
surely  simple.  It  is  a  question  of  measure ;  all  I  want 
to  say  is  that  we  are  nowadays  quite  unable  to  under- 
stand, to  express  in  formulas  and  in  laws,  what  an  in- 
sane person  feels.  We  can  hardly  connect  together  by 
general  laws  the  different  facts  observed  in  melancholic 
delirium  or  in  the  delirium  of  persecution.  On  the 
contrary,  the  various  accidents  of  hysteria,  though  so 
different  in  appearance,  are  easily  brought  close  to  one 
another  owing  to  common  characters.  We  can  dimly 
see  some  general  laws,  about  the  formula  for  which  we 
hesitate,  but  of  whose  existence  we  have  a  suspicion. 
That  is,  after  all,  the  reason  that  explains  the  character 
of  the  discussion  about  hysteria  nowadays.  While  no- 
body endeavours  to  give  or  to  discuss  a  general  defi- 
nition comprising  all  the  phenomena  of  epilepsy  or 
melancholia,  there  are  now  a  great  number  of  authors 
who  propose  to  explain  in  a  few  words,  in  a  single 
definition,  all  the  pathology  of  hysteria.  In  short,  I 


The  Problem  of  Hysteria  7 

was  right  in  saying  to  you  that  the  psychology  of  this 
disease  seems  now  to  be  simpler  than  the  conception 
of  other  mental  diseases.  It  is  the  reason  why  I  told 
you  that  the  psychology  of  this  disease  is  simple.  To 
this  primordial  reason  are  added  practical  reasons :  the 
hysteric  are  patients  who  are  easily  managed,  who  talk 
willingly,  who  are  not  dangerous,  on  whom  we  can 
experiment  without  any  great  fear,  and  who,  lastly,  like 
to  be  observed,  and  readily  lend  themselves  to  examina- 
tion. Such  are  the  reasons  why  the  first  studies  were 
devoted  to  this  kind  of  patients,  and,  in  following  the 
historical  order,  we  also  follow  the  practical  order, 
which  leads  us  to  begin  with  the  simplest  and  easiest 
disease. 

II 

Do  not  think,  however,  that  this  choice  of  the  study 
of  the  hysteric  is  only  justified  by  an  historical  chance 
and  by  reasons  of  convenience.  The  study  of  these 
patients,  if  happily  it  is  a  rather  easy  one,  is  at  the 
same  time  very  important,  both  from  the  philosophical 
and  scientific  and  from  the  medical  and  practical  point 
of  view.  I  am  convinced  that  in  our  times,  every  well- 
educated  man  wishing  to  have  an  opinion  on  moral  and 
philosophical  problems  ought  to  know  something  of  this 
singular  mental  disease,  for  it  has  played  a  considerable 
part  in  the  history  of  all  religions  and  superstitions, 
and  it  still  plays  a  very  important  part  in  the  most 
attractive  moral  questions.  A  great  French  alienist, 
Moreau  de  Tours,  was  in  the  habit  of  saying  that  all 
the  great  things  accomplished  in  the  world  have  been 


8          The  Major  Symptoms  of  Hysteria 

accomplished  by  mad  people.  It  is  perhaps  some- 
what exaggerated,  but  it  is  nevertheless  true  that  most 
great  creeds  have  spread  by  means  of  the  emotion 
caused  by  surprising  phenomena,  which  have  always 
been  due  to  hysteric  people.  In  the  development  of 
every  great  religion,  both  in  ancient  and  in  modern 
times,  there  have  always  been  strange  persons  who 
raised  the  admiration  of  the  crowd  because  their  nature 
seemed  to  be  different  from  human  nature.  Their 
manner  of  thinking  was  not  the  same  as  that  of  others ; 
they  also  had  extraordinary  oblivions  or  remembrances, 
they  had  visions,  they  saw  or  heard  what  others  could 
not  see  or  hear.  They  were  illumined  by  odd  con- 
victions; not  only  did  they  think  but  they  also  felt  in 
another  way  than  the  bulk  of  mankind;  they  had  an 
extraordinary  delicacy  of  certain  senses  joined  to  ex- 
travagant insensibilities  which  enabled  them  to  bear 
the  most  dreadful  tortures  with  indifference  or  even 
with  delight.  Not  only  did  they  feel  but  they  also  lived 
otherwise  than  other  people;  they  could  do  without 
sleep,  or  sleep  for  months  together;  they  lived  without 
eating  or  drinking,  without  satisfying  their  natural 
needs.  Is  it  not  such  persons  who  have  always  excited 
the  religious  admiration  of  peoples,  whether  sibyls, 
prophets,  pythonesses  of  Delphi  or  Ephesus,  or  saints 
of  the  Middle  Ages,  or  ecstatics,  or  illuminates  ?  Now 
they  were  considered  as  worthy  of  admiration  and 
beatified,  now  they  were  called  witches  or  demoniacs 
and  burnt;  but,  at  the  bottom,  they  always  caused 
astonishment  and  they  played  a  great  part  in  the 
development  of  dogmas  and  creeds. 


The  Problem  of  Hysteria  9 

Well,  all  these  phenomena,  as  you  know  already,  are 
the  usual  symptoms  of  hysteria,  and  there  is  not,  from 
this  point  of  view,  a  disease  which  has  played  so  great 
a  part  in  history.  If  I  am  not  mistaken,  it  is  still 
exactly  the  same  now:  we  have  changed  only  in  ap- 
pearance. We  beatify  but  few  saints  and  we  burn 
but  few  demoniacs,  yet  we  have  not  forgotten  them; 
they  have  become  our  somnambulists  and  mediums, 
and  every  time  we  want  to  throw  some  light  on  the 
mysteries  of  our  destiny,  to  penetrate  into  the  unknown 
faculties  of  the  human  mind,  to  whom  do  we  appeal? 
Whom  do  we  take  as  a  subject  of  observation?  Is  it 
an  ordinary  person,  a  person  in  good  health,  whom  we 
ask  to  foresee  the  future  or  to  talk  with  the  dead  ?  No ; 
it  is  a  neuropathic  patient,  insensible  to  the  things 
of  this  world,  but  whose  sensibility  is  overexcited  in  a 
certain  direction ;  medically  speaking,  it  is  a  hysteric 
person. 

Understand  me  well.  I  do  not  mean  at  all  to  tell 
you  that  these  studies  are  warped  by  this,  any  more 
than  I  deny  the  sanctity  of  a  personage  of  the  Middle 
Ages  whom  I  diagnosticate  as  hysteric.  A  hysterical 
person  may  be  a  saint ;  a  hysterical  person  may  have  a 
wonderful  lucidity:  that  is  undeniable.  I  only  want 
you  to  be  warned  of  what  happens  when  you  have  to 
judge  facts  of  this  kind.  When  we  have  to  appreciate 
facts  which  are  out  of  our  habitual  observation  and  look 
wonderful,  it  is  a  material  point  to  know  well  in  what 
conditions  they  present  themselves.  Now  in  the  ques- 
tion we  are  considering,  one  of  these  conditions,  the 
most  serious  one,  is  the  mental  state  of  the  persons  in 


io        The  Major  Symptoms  of  Hysteria 

whom  such  facts  are  observable.  So  you  must  know 
that  such  persons  are  hystericals,  and  be  accustomed  to 
the  laws  ruling  the  minds  of  hystericals.  Perhaps  there 
may  be  some  cases  in  which  this  ascertainment  does 
not  diminish  the  interest  taken  in  the  phenomenon,  but, 
believe  me,  it  mostly  takes  away  a  great  part  of  the 
wonderful.  To  judge  these  moral  and  philosophical 
problems,  it  is  indispensable  to  study  thoroughly  this 
disease  of  the  mind. 

This  remark  is  truer  still  if  you  consider  the  subject 
from  a  medical  and  practical  point  of  view.  You  who 
have  chosen  the  medical  career  and  will  have  to  attend 
patients  belonging  to  every  class  of  society:  bear  in 
mind  that  you  will  constantly  meet  with  neuropathic 
phenomena  connected  with  this  group  of  neuroses  and 
that  you  will  commit  the  most  dangerous  mistakes  if 
you  are  not  very  well  accustomed  to  the  aspects  and 
evolution  of  hysteria.  It  was  the  fashion  for  a  certain 
time  to  say  that  hysteria  was  a  very  rare  disease;  you 
know  that  it  had  a  bad  reputation,  that  a  kind  of  dis- 
honour was  attached  to  this  word,  and  that  people  tried 
to  persuade  themselves  that  this  shameful  disease  was 
not  of  frequent  occurrence.  By  a  kind  of  international 
irony,  people  were  willing  to  admit,  after  the  innumer- 
able studies  made  by  French  physicians,  that  hysteria 
was  frequent  only  among  French  women,  which  as- 
tonished nobody,  on  account  of  their  bad  reputation. 
Do  not  believe  this  nonsense.  American  women  are 
terribly  like  French  women.  I  was  not  astonished  there- 
fore, when,  two  years  ago,  at  the  Chicago  County  Hospital 
and  at  the  Boston  City  Hospital,  some  kind  fellow- 


The  Problem  of  Hysteria  n 

physicians  immediately  showed  me  hysteric  women, 
humorously  adding  that  they  were  quite  the  same  as 
those  of  La  Salpetriere.  The  difference  of  races  is  also 
one  of  those  silly  things  which  the  human  mind  has 
much  difficulty  in  getting  rid  of.  All  civilized  nations 
are  now  the  same:  we  have  the  same  mind  and  the 
same  body,  and,  it  must  be  recognized,  the  same  miseries. 
If  the  hysterical  seemed  to  be  less  numerous  in  other 
countries,  it  is  first  because  physicians  did  not  recognize 
them,  then  because  they  would  not  give  them  their  real 
appellation.  When  medical  instruction  is  more  general 
in  this  matter,  when  prejudices  have  vanished,  it  will 
probably  be  acknowledged  that  in  this  matter,  as  in 
many  others,  the  other  nations  have  no  reason  for 
envying  France. 

So  you  will  often  meet  with  hysterical  people.  You 
will  call  them  neurasthenic  for  the  family,  if  you  like. 
I  don't  care.  I  only  wish  that  you  should  at  least  know 
what  is  the  matter.  You  must  be  able  quickly  to 
recognize  this  disease,  in  order  to  foresee  its  evolution, 
to  provide  against  its  dangers,  and  immediately  to  begin 
a  rational  treatment.  This  early  diagnosis  is  much 
more  important  still  from  another  point  of  view:  it 
will  keep  you,  allow  me  to  tell  you  plainly,  from  making 
blunders.  It  is  perhaps  not  very  serious  not  to  recognize 
a  hysterical  accident  and  not  to  treat  it ;  but  what  is 
always  very  serious  is  to  mistake  a  hysterical  accident 
for  another  one,  and  to  treat  it  for  what  it  is  not.  You 
cannot  imagine  the  medical  blunders,  and  too  often 
also  the  medical  crimes,  committed  in  this  way.  One 
of  the  greatest  difficulties  in  the  medical  art  and  one  of 


12        The  Major  Symptoms  of  Hysteria 

the  greatest  misfortunes  of  patients  is  that  hysterical 
diseases  are  only  well  characterized  from  the  moral 
point  of  view,  which  usually  is  not  examined  at  all ;  that 
they  are  very  badly  characterized  from  the  physical 
point  of  view,  and  that  they  are  uncommonly  similar  to 
all  kinds  of  medical  or  surgical  affections,  for  which 
they  are  easily  mistaken.  Contractures,  paralyses, 
anesthesias,  various  pains,  especially  when  they  are 
seated  in  the  viscera,  may  simulate  anything ;  and  then 
you  have  the  legion  of  false  tuberculoses  of  the  lungs, 
of  false  tumours  of  the  stomach,  of  false  intestinal  ob- 
structions, and  above  all,  of  false  uterine  and  ovarian 
tumours.  What  happens  as  to  the  viscera  also  exists 
as  to  the  limbs  and  the  organs  of  the  senses.  Some 
hysterical  disturbances  are  mistaken  for  lesions  of  the 
bones,  of  the  rachis,  for  muscular  or  tendinous  lesions. 
Then  the  physician  interposes,  frightens  the  family, 
agitates  the  patient  to  the  utmost,  and  prescribes  ex- 
traordinary diets,  perturbing  the  life  and  exhausting  the 
strength  of  the  sick  person.  Finally,  the  surgeon  is 
called  in.  Do  not  try  to  count  the  number  of  arms  cut 
off,  'of  muscles  of  the  neck  incised  for  cricks,  of  bones 
broken  for  mere  cramps,  of  bellies  cut  open  for  phantom 
tumours,  and  especially  of  women  made  barren  for  pre- 
tended ovarian  tumours.  Humanity  ought  indeed  to 
do  homage  to  Charcot  for  having  prevented  a  greater 
depopulation.  These  things  no  doubt  have  decreased, 
but  they  are  still  done  every  day.  Not  long  ago  I  saw 
a  patient  who  had  had  an  eye  excised  and  the  optic 
nerve  cut  out  for  mere  neuropathic  pains.  If  I  could 
only,  by  calling  your  attention  and  interest  to  the  knowl- 


The  Problem  of  Hysteria  13 

edge  of  this  disease,  contribute  to  diminish  the  number 
of  these  medical  crimes,  I  should  already  have  attained 
a  very  important  result. 


Ill 

In  order  to  be  able  to  enter  upon  the  study  of  hysteria 
in  a  profitable  way,  allow  me,  before  I  end  the  intro- 
duction, to  summarize  in  a  few  words  the  history  of  the 
studies  which  have  been  made  on  this  disease.  We  are 
not  isolated  in  our  studies :  we  come  after  generations 
of  other  students,  and  we  always  ought,  before  we  begin 
our  own  researches,  to  try  to  see  our  way  exactly.  We 
ought  to  see  at  what  point  of  medical  history  we  are 
standing,  what  has  been  done  and  well  done  before  us, 
what  we  have  not  to  begin  again.  We  ought  to  realize 
the  difficulties  that  stopped  our  predecessors,  in  order 
to  add  our  efforts  to  theirs,  and  to  make  some  steps 
forward  in  the  way  they  have  laid  down  for  us.  The 
history  of  these  studies  would  be  a  very  long  one,  for 
they  began  in  the  remotest  antiquity:  Democritus 
already  has  his  theory  about  hysteria.  But  I  think 
that  we  can  summarize  this  long  history  in  a  few 
words  by  establishing  a  few  great  divisions,  and  I  pro- 
pose to  you  to  adopt  three  great  divisions.  At  first  this 
history  was  anecdotical  and  descriptive :  it  is  a  period 
of  curiosity  and  of  somewhat  uneasy  and  uncritical 
admiration.  It  is  the  period  of  sibyls,  witches,  con- 
vulsionists  of  all  kinds,  and  of  miscellanies  of  surprising 
facts  about  convulsions,  somnambulisms,  resurrections 
of  lethargic  people,  extraordinary  fastings,  miraculous 


14        The  Major  Symptoms  of  Hysteria 

wounds,  etc.  The  second  period,  which,  in  reality, 
began  very  late,  only  in  the  nineteenth  century,  might 
be  called  the  clinical  period;  then  physicians  sought, 
above  all,  to  give  a  medical  character  to  this  disease, 
to  distinguish  it  from  other  maladies,  and  to  recognize 
the  phenomena  that  appertain  to  it.  It  is  a  kind  of 
clearing  away  and  classification.  The  third  period, 
which  is  quite  contemporary,  deserves  to  be  called  the 
psychological  period;  for,  right  or  wrong,  it  is  among 
mental  phenomena  that,  for  these  thirty  years,  the 
interpretation  has  been  sought  of  these  innumerable 
phenomena  which  our  first  ancestors  had  only  described 
and  which  their  successors  contented  themselves  with 
classifying.  Later,  perhaps,  there  will  come  an  ana- 
tomical and  physiological  period,  but,  in  my  opinion,  it 
does  not  yet  exist. 

A  word  only  about  each  of  these  great  stages.  In  the 
first,  it  is  sufficient  to  remind  you  of  the  names  of  Plato, 
Hippocrates,  Celsus,  Galienus,  ^Etius,  of  the  authors 
who,  in  the  middle  ages,  described  possessions,  choreas, 
epidemics  of  tarentism.  Among  them  are  Ambroise 
Pare*  and  Fernel.  A  little  later  we  have  to  cite  Charles 
Lepois,  who  gave  in  the  seventeenth  century  one  of  the 
best  descriptions;  Sydenham,  who  made  known  the 
hysterical  nail,  coughing,  vomiting,  and  oedema ;  Raulin 
(1758),  who  supported  the  opinion  of  Sydenham,  and 
was  one  of  the  first  to  maintain  that  there  were  hysteric 
men;  Witt  (1767),  Sauvage  (1760),  Astruc  (1761),  and 
Pomme  (1760-1782),  who  discussed  this  strange  problem. 
This  descriptive  period  was,  in  fact,  disturbed  by  a 
puerile  and  dangerous  conception  which  vitiated  all  the 


The  Problem  of  Hysteria  15 

studies  and  made  any  attempt  at  an  interpretation  im- 
possible. You  know  the  old  revery  of  Plato  in  the 
Timaus:  "The  matrix  is  an  animal  which  longs  to 
generate  children.  When  it  remains  barren  for  a  long 
time  after  puberty,  it  finds  it  difficult  to  bear,  it  feels 
wroth,  it  goes  about  the  whole  body,  closing  the  issues 
for  the  air,  stopping  the  respiration,  putting  the  body 
into  extreme  dangers,  and  occasioning  various  diseases, 
until  desire  and  love,  bringing  man  and  woman  together, 
make  a  fruit  and  gather  it  as  from  a  tree."  This  pretty 
little  story  was  for  half  a  score  of  centuries  the  only 
interpretation  of  hysteria,  and  still  originated  all  the 
foolish  ideas  expressed  by  Louyer  de  Villermay  in  1860. 
You  may  guess  the  part  played  in  this  respect  by  the 
abdominal  pains  seated  at  the  level  of  ovaries,  by  the 
movements  of  the  hysterical  nail,  by  the  suffocations  of 
the  patients  during  their  fits.  As  hysteria  required  an 
uterus  (va-repov),  its  existence  was  not  admitted  in 
men,  and  the  first  serious  discussions  bore  on  the  exist- 
ence of  masculine  hysteria. 

The  recognition  of  this  disease  in  men  changed  the 
old  conception  of  hysteria  and  determined  an  ensemble 
of  more  precise  clinical  researches.  Without  pretend- 
ing to  any  chronological  precision,  we  place  at  the 
beginning  of  the  nineteenth  century  the  inauguration 
of  the  second  and  truly  clinical  period.  It  is  sufficient 
to  remind  you  of  the  names  of  Georget  (1821),  of  Hufe- 
land  in  Germany  (1836),  of  Brachet  and  of  Landouzy 
in  France  (1845),  °f  Duchenne  de  Boulogne  (1855),  of 
Legrand  du  Saulle  (1860).  But  I  must  insist  on  the 
beautiful  book  of  the  English  physician  Brodie  (1837), 


\6        The   Major  Symptoms  of  Hysteria 

who  described  the  sensitive  and  motor  disturbances  in 
the  articulations,  and  who  has  given  his  name  to  an 
hysterical  accident,  the  knee  of  Brodie.  We  must  accord 
a  good  place  to  the  work  of  Briquet  (1859) ;  it  was  the 
first  general  work  of  real  value  and  it  prepared  the  way 
for  the  contemporary  studies.  Lastly,  you  know  that 
the  most  eminent  representative  of  that  period  is 
Charcot,  who  in  every  way  gave  more  precision  to  the 
clinical  knowledge  of  hysteria. 

With  these  studies  are  connected  the  distinction  be- 
tween the  epileptic  and  the  hysterical  fit,  which  was  for 
a  long  time  considered  impossible;  the  diagnosis  of 
apoplexies,  cerebral  lesions,  meningites,  of  hysterical 
mutisms,  and  fits  of  sleep;  the  separation  between 
hysterical  anorexics,  gastralgias,  and  dyspnaeas,  and  the 
organic  diseases  which  are  apparently  seated  in  the 
same  viscera.  It  is  chiefly  to  the  patient  studies  of  our 
predecessors  that  we  owe  the  discovery  and  diagnosis 
of  the  different  motor  accidents  of  hysteria,  of  the 
articular  disturbances  analogous  to  the  knee  of  Brodie, 
of  the  contractures,  of  the  paralyses  limited  to  one 
limb.  Discussions  relating  to  these  motor  accidents, 
their  comparison  with  the  diverse  organic  paralyses,  re- 
searches on  the  traumatic  neuroses,  filled,  as  you  know, 
the  career  of  Charcot. 

In  all  these  studies  there  was  no  room  yet  for  an 
interpretation  of  the  disease,  and  Charcot  felt  thoroughly 
the  necessity  of  an  interpretation  of  this  kind.  It  was 
indispensable,  not  only  in  order  to  explain  things  ap- 
parently mysterious,  but  chiefly  to  give  a  unity  capable 
of  linking  together  those  innumerable  symptoms  that 


The  Problem  of  Hysteria  17 

looked  so  heterogeneous.  Lasegue  had  already  said 
that  "manifestations  apparently  the  most  disorderly 
have  not  the  individual  character  one  supposes,  and 
they  are  not  inexplicable  exceptions."  "  Nothing  is  left 
to  chance,"  said  Charcot ;  "on  the  contrary,  all  happens 
according  to  rules,  always  the  same,  common  to  private 
and  hospital  practice,  applicable  to  all  countries,  to  all 
times,  to  all  races."  He  naturally  sought  to  discover 
this  determinism  and  these  general  laws  of  hysteria. 
Carried  along  by  his  habits  as  a  clinician,  he  has,  I 
think,  sought  these  general  laws  too  much  in  the  physi- 
ological domain,  which  led  him  to  a  certain  number 
of  regrettable  errors.  In  opposition  to  his  school  other 
studies,  and  in  particular  those  of  M.  Bernheim  in 
Nancy,  have  shown  that  this  unity  of  hysteria,  this  in- 
terpretation of  the  symptoms  it  presents,  would  be 
much  more  surely  found  -in  the  domain  of  the  moral 
phenomena. 

The  contest  of  the  two  schools  was  the  occasion  of 
the  development  of  psychological  pathology,  of  which 
I  have  spoken  to  you,  and  brought  on  the  beginning  of 
the  third  period,  the  psychological  period  of  the  studies 
in  hysteria. 

This  period,  which  has  already  lasted  for  about 
twenty  years,  is  still  difficult  to  judge.  It  seems  to  me, 
however,  that  its  first  clear  results,  though  interesting, 
are  still  very  incomplete,  and  that  I  ought  to  warn 
you  against  their  attractive  simplicity.  A  certain  num- 
ber of  authors  have  been  seduced  by  the  psychological 
explanation.  It  seemed  to  them  that  the  mere  words 
"moral "  and  "thought"  were  enough  to  explain  every- 


1 8        The  Major  Symptoms  of  Hysteria 

thing,  and,  as  people  generally  like  simple  explana- 
tions, physicians  are  too  disposed  nowadays  to  be  con- 
tent with  a  vaguely  mental  explanation.  Hysteria,  they 
say,  is  a  psychic  disease ;  it  is  the  disease  of  suggestion, 
taken  in  a  vague  sense;  it  consists  in  disturbances 
which  the  patients  persuade  themselves  that  they  have ; 
it  is  the  disease  of  persuasion.  Many  physicians  think 
that,  when  they  have  expressed  a  few  formulas  of  this 
kind,  nothing  remains  to  be  said.  There  is  some  truth 
in  this  view,  for  it  brings  into  relief  the  psychic  charac- 
ter of  the  affection;  but  it  is  quite  insufficient.  We 
should,  in  my  opinion,  retain  something  of  the  precise 
method  of  Charcot,  of  the  search  after  the  determina- 
tion and  the  laws  of  hysteria,  and  apply  it  only  to  the 
psychological  fact,  instead  of  always  seeking  for  this 
determinism  in  physical  facts.  We  must  therefore  use 
a  certain  preciseness  in  the  description  and  study  of 
the  moral  phenomena  of  hysteria. 

The  description  of  such  a  disease  is  very  difficult,  first 
because  the  symptoms  are  exceedingly  numerous.  You 
know  that  formerly  Sydenham  called  it  a  Proteus,  an 
ever-changing  malady.  But  the  description  is  also 
difficult  because  the  disease  is  not  clearly  defined,  be- 
cause its  limits,  unfortunately,  are  very  vague.  It  is 
easy  to  see  that  many  contemporary  authors  do  not 
quite  agree  about  what  they  describe  under  the  name 
of  hysteria,  and  that  some  have  a  much  broader  concep- 
tion of  the  disease  than  others.  This  indecision  generally 
surprises  young  people.  You  think  that,  in  science, 
things  are  perfectly  definite,  and  you  are  very  much 
astonished  to  find  indecision  in  your  masters.  In 


The  Problem  of  Hysteria  19 

reality  definiteness  does  not  exist  in  natural  phenomena ; 
it  exists  but  in  our  systematic  descriptions.  It  is  the 
men  of  science  who  cut  separate  pieces  out  of  a  whole 
that  nature  has  made  continuous.  Do  you  believe  that 
animal  species  are  sharply  distinguished  from  one  an- 
other? Look  at  the  quarrels  of  naturalists  about  the 
limits  of  the  classes,  about  the  animals  of  transition, 
which  may  at  will  be  connected  with  one  class  or  an- 
other. Remember  the  doctrine  of  evolution  and  the 
origin  of  species  of  Darwin.  All  this  is  still  truer  in 
regard  to  diseases,  which,  in  reality,  have  not  the  dis- 
tinctness we  invent.  Physicians,  it  is  true,  may  agree 
in  certain  cases,  when  there  is  a  distinctly  visible 
objective  phenomenon  characterizing  such  or  such  a 
lesion — histologic  analysis  will  serve  to  define  a  syphilitic 
lesion;  in  other  cases,  the  presence  of  a  microscopic 
organism  will  be  a  guiding  mark,  and  the  recognition 
of  the  bacillus  of  Koch  will  define  a  tuberculous  lesion. 
But  unfortunately  we  have  nothing  of  the  kind  at  our 
disposal  to  define  the  diseases  of  the  mind.  Save  the 
case  of  general  paralysis,  there  is  no  anatomical  means 
to  distinguish  a  patient  labouring  under  the  mania  of 
persecution  from  the  one  who  is  affected  with  melan- 
cholia or  neuropathy.  When  you  have  found  the  mi- 
crobe of  hysteria,  you  will  be  able  to  transform  all  my 
descriptions  and  to  make  them  much  more  accurate. 

Nowadays  there  is  evidently  a  hypothetic,  conven- 
tional part  in  the  description  and  definition  of  a  mental 
disease.  Nobody,  I  think,  felt  so  clearly  the  necessity 
of  such  hypotheses  and  conventions  as  Charcot  when 
he  exposed  what  he  called  the  method  of  types.  When 


2O        The  Major  Symptoms  of  Hysteria 

one  wishes  to  describe  a  nervous  disease,  one  must  not 
fancy  that  one  may  comprise  in  its  description  all 
possible  subjects.  There  are  always  some  indistinct 
phenomena,  some  aberrant  cases,  some  contradictory 
symptoms.  In  this  case,  if  one  tried  to  satisfy  every- 
body, one  would  satisfy  nobody;  by  seeking  to  be  too 
true,  one  would  be  unintelligible.  One  must  determine 
on  making  a  necessary  hypothesis,  which  characterizes 
the  teaching  and  the  opinion  of  a  master;  one  must 
choose  among  the  innumerable  cases  of  the  disease  that 
which,  in  one's  personal  experience,  appears  to  be  the 
most  important,  that  which  presents  the  most  definite 
phenomena,  the  most  distinct  from  other  maladies,  the 
most  frequent  with  patients  of  the  same  kind,  the  most 
intelligible.  This  patient  becomes  a  type,  which  one 
describes  by  preference,  though  one  knows  very  well 
that  all  the  others  are  not  absolutely  like  it,  but  because 
one  supposes  that  they  deserve  the  same  name  in  the 
measure  in  which  they  resemble  it. 

This  is  what  I  shall  try  to  do  before  you  in  describing 
the  major  symptoms  of  hysteria.  This  word  major  in- 
dicates well  that  I  do  not  pretend  to  describe  all  possible 
hystericals  or  all  the  shades  these  symptoms  may 
present,  but  that  I  only  wish  to  show  you  what,  in 
my  hypothesis,  characterizes  the  typical  symptoms  of 
hysteria.  Such  symptomatic  and  hypothetic  descrip- 
tions have  the  inconvenience  of  being  transitory,  of  dis- 
appearing very  soon  after  us,  but  it  would  be  a  singular 
illusion  to  seek  to  do  something  eternal.  One  has 
already  obtained  a  great  result  when  one  has  done 
something  momentarily  intelligible  and  useful.  Charcot, 


The  Problem  of  Hysteria  11 

whose  method  I  cited  to  you,  applied  it  in  a  rather 
exaggerated  degree  in  his  description  of  hysteria;  he 
described  a  type  of  hysterical  which  disappeared  with 
him ;  nobody  nowadays  any  longer  describes  the  attack 
of  hysteria  as  Charcot  did.  I  think,  however,  that  his 
description  did  service  to  many  a  generation  of  students. 
It  brought  about  an  enormous  scientific  movement, 
which  we  continue  by  discussing  it.  No  doubt,  our 
types  of  hysterical  phenomena  are  ephemeral  like  his. 
We  wish  they  may  have  the  same  usefulness  for  some 
time. 

If  I  succeed  in  presenting  to  you  a  few  simple  types, 
intelligible  for  you,  of  the  mental  state  that  is  called 
somnambulism,  of  the  mental  state  that  brings  about 
the  functional  paralyses  and  insensibilities,  I  shall,  I 
hope,  have  interested  you  in  these  studies  of  patho- 
logical psychology,  indispensable  nowadays  to  the  under- 
standing of  philosophical  and  moral  problems ;  I  shall 
have  helped  you  a  little  to  play  later  on  your  part  as 
physicians,  for  a  physician  should  attend  to  the  thought 
of  his  patient ;  I  shall  thus  have  accomplished,  partially 
at  least,  the  wishes  formed  by  your  masters  of  Harvard 
school  when  they  did  me  the  great  honour  to  call  me 
among  them. 


LECTURE   II 
MONOIDEIC  SOMNAMBULISMS 

Somnambulism  as  the  typical  form  of  hysterical  accidents  — 
Description  0}  some  cases  of  monoideic  somnambulisms  — 
Their  essential  psychological  characters —  The  emanci- 
pation, the  dissociation  of  an  idea,  of  a  partial  system 
of  thoughts  in  somnambulism 

THE  several  conceptions  of  an  illness  are  characterized 
by  the  choice  of  the  symptoms  described  first  and  con- 
sidered as  the  most  important  ones.  During  a  long 
time  hysteria  was  considered  as  a  chiefly  physical  dis- 
ease, and  consequently  convulsions,  in  all  appearance 
deprived  of  intelligence,  were  put  on  the  first  line. 
Hysteria  was,  above  all,  a  convulsive  illness  whose 
most  important  symptom  was  the  fit.  Charcot  has  still 
continued  that  tradition,  and  you  know  the  pains  he 
took  to  explain  all  that  illness  in  taking  as  a  starting- 
point  the  convulsive  attack.  His  theory  is  nowadays 
considered  very  artificial,  and  his  schematic  conception 
of  the  attacks  tends  to  fall  into  oblivion;  that  lack  of 
success  I  easily  explain  through  his  error  of  the  starting- 
point.  The  hysterical  fit  of  convulsions,  far  from  being 
a  simple  phenomenon,  is,  on  the  contrary,  a  very 
variable  and  complex  symptom.  The  convulsions  have 
all  sorts  of  meaning ;  sometimes  they  are  in  connection 
with  sensations  or  ideas  and  very  complicated  states 

22 


Monoideic  Somnambulisms  23 

of  consciousness ;  sometimes  they  are  nearly  deprived 
of  consciousness;  in  certain  cases  they  are  linked  to 
habits  and  grimaces,  or  depend  upon  moving  agitation 
in  connection  with  certain  voluntary  paralyses.  It 
may  be  said  that  for  some  rather  aged  patients,  whose 
illness  has  lasted  a  long  time,  the  convulsive  attack 
sums  up  all  the  hysterical  accidents  they  have  had  since/ 
the  beginning  of  the  disease.  The  attack  I  consider  as 
a  complex  phenomenon  that  ought  to  be  studied  rather 
at  the  end  of  a  course  of  lectures  than  at  the  beginning. 
To  characterize  at  once  the  spirit  of  my  teaching  and 
to  make  you  understand  how  to  construe  that  nervous 
affection  from  the  moral  point  of  view,  I  ask  you  to  put 
in  the  first  line,  as  the  most  typical,  the  most  character- 
istic symptom  of  hysteria,  a  moral  symptom,  —  that  is 
somnambulism,  —  the  fit  of  somnambulism  which 
appears  spontaneously  in  hystericals.  This  is  a  new 
medical  conception  which  I  consider  an  important  one. 

Somnambulism  has  been  too  long  considered  as  a 
rare  phenomenon,  impossible  to  explain,  that  adds  itself 
to  the  habitual  troubles  of  neuropaths.  To  me  som- 
nambulism is,  on  the  contrary,  extremely  frequent  under 
various  forms,  that  may  more  or  less  conceal  it.  Som- 
nambulism does  not  add  itself  to  all  sorts  of  neuropathic 
troubles ;  it  constitutes  the  material  point  of  a  peculiar 
neurosis, — hysteria.  If  one  understands  somnambulism 
well,  one  is,  I  believe,  capable  of  understanding  all 
hysterical  phases  that  are  more  or  less  constructed  on 
the  same  model. 

But  among  the  various  somnambulisms,  a  type  must 
be  chosen  to  be  first  studied.  Here  we  will  not  choose 


24        The  Major  Symptoms  of  Hysteria 

the  form  that  occurs  most  frequently,  but  the  necessity 
of  teaching  will  induce  us  to  choose  the  simplest  form 
and  the  easiest  to  understand.  This  simple  form  of 
somnambulism  deserves  to  be  called  monoideic,  and 
that  name  will,  I  hope,  be  justified  by  this  lecture. 
Thus  we  have  to  examine  together  the  typical  forms 
of  monoideic  somnambulism ;  we  shall  then  expose  its 
essentially  psychological  character,  and  we  shall  end 
by  trying  to  sum  up  in  a  simple  and  general  conception 
the  character  of  these  somnambulisms,  in  order  to  com- 
pare gradually  that  first  conception  with  those  we  shall 
draw  from  the  study  of  other  hysterical  phenomena. 


What,  then,  exactly,  is  a  somnambulist?  Popular 
observation  has  answered  long  ago :  it  is  an  individual 
who  thinks  and  acts  while  he  is  asleep.  Without  a 
doubt  that  answer  is  not  very  clear,  for  we  don't  know 
very  well  what  sleep  is.  That  answer  means  only  that 
the  person  spoken  of  thinks  and  acts  in  an  odd  way, 
different  from  that  of  other  people,  and  that  at  the  same 
time  that  person  is  in  some  way  like  a  person  asleep. 
You  will  find  nowhere  a  more  beautiful  description  of 
this  popular  conception  of  somnambulism  than  in 
Shakespeare's  tragedy,  Macbeth:  — 

Doctor.  I  have  two  nights  watched  with  you,  but  can  perceive 
no  truth  in  your  report.  When  was  it  she  last  walked? 

Gentlewoman.  Since  his  majesty  went  into  the  field,  I  have 
seen  her  rise  from  her  bed,  throw  her  nightgown  upon  her, 
unlock  her  closet,  take  forth  paper,  fold  it,  write  upon  't,  read  it, 


Monoideic  Somnambulisms  25 

afterwards  seal  it,  and  again  return  to  bed;  yet  all  this  while  in 
a  most  fast  sleep. 

Doctor.  A  great  perturbation  in  nature,  to  receive  at  once  the 
benefit  of  sleep  and  do  the  effects  of  watching !  In  this  slumbery 
agitation,  besides  her  walking  and  other  actual  performances, 
what  at  any  time  have  you  heard  her  say? 

Gentlewoman.  That,  sir,  which  I  will  not  report  after  her. 

Doctor.   You  may  to  me,  and  't  is  most  meet  you  should. 

Gentlewoman.  Neither  to  you  nor  any  one,  having  no  witness 
to  confirm  my  speech. 

Enter  LADY  MACBETH,  with  a  taper 

Lo  you,  here  she  comes !  This  is  her  very  guise ;  and,  upon 
my  life,  fast  asleep !  Observe  her ;  stand  close. 

Doctor.   How  came  she  by  that  light? 

Gentlewoman.  Why,  it  stood  by  her;  she  has  light  by  her 
continually,  't  is  her  command. 

Doctor.   You  see,  her  eyes  are  open. 

Gentlewoman.   Ay,  but  their  sense  is  shut. 

Doctor.  What  is  it  she  does  now?  Look,  how  she  rubs  her 
hands. 

Gentlewoman.  It  is  an  accustomed  action  with  her,  to  seem 
thus  washing  her  hands;  I  have  known  her  continue  in  this  a 
quarter  of  an  hour. 

Lady  Macbeth.   Yet  here  's  a  spot. 

Doctor.  Hark !  she  speaks ;  I  will  set  down  what  comes 
from  her,  to  satisfy  my  remembrance  the  more  strongly. 

Lady  Macbeth.  Out,  damned  spot !  out,  I  say !  —  One,  two ; 
why,  then  't  is  time  to  do  't.  —  Hell  is  murky !  —  Fie,  my  lord, 
fie !  a  soldier,  and  afeard  ?  What  need  we  fear  who  knows  it, 
when  none  can  call  our  power  to  account  ?  —  Yet  who  would 
have  thought  the  old  man  to  have  had  so  much  blood  in  him? 

Doctor.   Do  you  mark  that? 

Lady  Macbeth.  The  thane  of  Fife  had  a  wife;  where  is  she 
now  ?  —  What,  will  these  hands  ne'er  be  clean  ?  —  No  more  o' 
that,  my  lord,  no  more  o'  that;  you  mar  all  with  this  starting. 

Doctor.   Go  to,  go  to;   you  have  known  what  you  should  not 


26        The  Major  Symptoms  of  Hysteria 

Gentlewoman.  She  has  spoke  what  she  should  not,  I  am  sure 
of  that;  heaven  knows  what  she  has  known. 

Lady  Macbeth.  Here  's  the  smell  of  the  blood  still;  all  the 
perfumes  of  Arabia  will  not  sweeten  this  little  hand.  Oh,  oh,  oh ! 

Doctor.  What  a  sigh  is  there!    The  heart  is  sorely  charged. 

Gentlewoman.  I  would  not  have  such  a  heart  in  my  bosom 
for  the  dignity  of  the  whole  body. 

Doctor.   Well,  well,  well,  — 

Gentlewoman.   Pray  God  it  be,  sir. 

Doctor.  This  disease  is  beyond  my  practice ;  yet  I  have  known 
those  which  have  walked  in  their  sleep  who  have  died  holily  in 
their  beds. 

Lady  Macbeth.  Wash  your  hands,  put  on  your  nightgown; 
look  not  so  pale.  —  I  tell  you  yet  again,  Banquo  's  buried ;  he 
cannot  come  out  on  's  grave. 

Doctor.   Even  so? 

Lady  Macbeth.  To  bed,  to  bed !  there  's  knocking  at  the 
gate;  come,  come,  come,  come,  give  me  your  hand.  What  's 
done  cannot  be  undone.  To  bed,  to  bed,  to  bed !  [Exit. 

Doctor.   Will  she  go  now  to  bed? 

Gentlewoman.   Directly. 

Doctor.   Foul  whisperings  are  abroad.    Unnatural  deeds 
Do  breed  unnatural  troubles;   infected  minds 
To  their  deaf  pillows  will  discharge  their  secrets. 
More  needs  she  the  divine  than  the  physician.  — 
God,  God  forgive  us  all!  —  Look  after  her; 
Remove  from  her  the  means  of  all  annoyance, 
And  still  keep  eyes  upon  her.     So,  good  night; 
.My  mind  she  has  mated,  and  amaz'd  my  sight. 
I  think,  but  dare  not  speak. 

Gentlewoman.  Good  night,  good  doctor. 

[Exeunt. 

Our  modern  examples  are  much  less  dramatic,  but 
they  may  be  compared  as  to  their  most  striking  features. 
Let  me  cite  a  certain  number  of  cases  to  impress  upon 


Monoideic  Somnambulisms  27 

your  mind  the  idea  of  this  phenomenon,  which  to  me 
is  a  very  important  one.  Here  is  a  first  instance:  A 
young  woman,  twenty-nine  years  old,  called  Gib., 
intelligent,  sensitive,  hears  one  day  abruptly  some  dis- 
astrous news.  Her  niece,  who  lives  next  door,  has  just 
died  in  dreadful  circumstances.  She  rushes  out,  and 
comes,  unhappily,  in  time  to  see  the  body  of  the  young 
girl  lying  in  the  street.  She  had  thrown  herself  out 
of  the  window  in  a  fit  of  delirium.  Gib.,  although  very 
much  moved,  remains  to  all  appearance  calm,  helping 
to  make  everything  ready  for  the  funeral.  She  goes 
to  the  funeral  in  a  very  natural  way.  But  from  that 
time  she  grows  more  and  more  gloomy,  her  health  fails, 
and  we  may  notice  the  beginning  of  the  singular  symp- 
toms we  are  going  to  speak  of.  Nearly  every  day,  at 
night  and  during  the  day,  she  enters  into  a  strange 
state;  she  looks  as  if  she  were  in  a  dream,  she  speaks 
softly  with  an  absent  person,  she  calls  Pauline  (the  name 
of  her  lately  deceased  niece),  and  tells  her  that  she  ad- 
mires her  fate,  her  courage,  that  her  death  has  been  a 
beautiful  one.  She  rises,  goes  to  the  windows  and  opens 
them,  then  shuts  them  again,  tries  them  one  after  an- 
other, climbs  on  the  window,  and,  if  her  friends  did 
not  stop  her,  she  would,  without  any  doubt,  throw 
herself  out  of  the  window.  She  must  be  stopped, 
looked  after  incessantly,  till  she  shakes  herself,  rubs  her 
eyes,  and  resumes  her  ordinary  business  as  if  nothing 
had  happened. 

A  curious  case  I  have  lately  observed  is  that  of  He., 
which  I  have  related  with  more  particulars  in  another 
of  my  works.  That  woman,  a  hysterical  thirty-five 


28        The  Major  Symptoms  of  Hysteria 

years  old,  was  taking  a  walk  in  the  zoological  garden 
during  her  menstrual  period,  when  she  was  frightened 
by  a  lioness  that,  as  it  was  reported,  seemed  ready  to 
rush  upon  her.  When  she  came  back  to  the  hospital, 
she  had  a  fit  of  delirium  that  lasted  for  eight  days. 
After  some  interruption,  she  again  had  fits  of  the  same 
odd  delirium.  In  these  crises  she  runs  on  all  fours, 
roars,  rushes  on  people,  trying  to  bite  them;  and  al- 
though she  was  anorexic  before  her  attack  and  could  eat 
very  little,  now  she  pounces  on  all  sorts  of  food,  picks 
it  up  with  her  teeth,  and  devours  bits  of  paper  and 
small  objects  she  finds  on  the  floor.  In  a  word,  she 
acts  a  comedy  wherein  she  believes  herself  to  be  a  lion- 
ess. I  say  that  she  acts  a  comedy,  for  it  becomes 
certain  that  she  studies  her  part,  and  that  she  often  re- 
places real  actors  by  metaphors.  For  instance,  she 
looks  in  a  drawer  for  photographs,  generally  children's 
portraits,  and  tries  to  eat  them  up.  Without  any  doubt, 
as  she  is  unable  to  devour  real  persons,  she  devours 
them  in  effigy.  I  won't  insist  on  the  form  here  borrowed 
by  the  idea  rooted  in  her  mind ;  it  is  one  of  those  changes 
in  personality  brought  about  by  a  suggestion  or  an 
invading  idea  which  are  already  well  known.  At  the 
same  time  we  may  observe  in  He.,  when  she  is  awake, 
a  very  complete  amnesia,  that  spreads  not  only  upon  the 
delirium,  but  also  upon  the  walk  at  the  zoological  garden. 
Third  observation:  A  man  of  thirty-two,  Sm.,  pre- 
sents a  still  more  singular  case.  He  usually  remains 
in  bed,  for  both  his  legs  are  paralyzed.  We  won't 
occupy  ourselves  with  that  paralysis  to-day,  although  it 
is  a  very  odd  one.  In  the  middle  of  the  night  he  rises 


Monoideic  Somnambulisms  29 

slowly,  jumps  lightly  out  of  bed,  —  for  the  paralysis  we 
have  just  spoken  of  has  quite  vanished,  —  takes  his 
pillow  and  hugs  it.  We  know  by  his  countenance 
and  by  his  words  that  he  mistakes  this  pillow  for  his 
child,  and  that  he  believes  he  is  saving  his  child  from 
the  hands  of  his  mother-in-law.  Then,  bearing  that 
weight,  he  tries  to  slip  out  of  the  room,  opens  the  door, 
and  runs  out  through  the  court-yard;  climbing  along 
the  gutter,  he  gets  to  the  housetop,  carrying  his  pillow 
and  running  all  about  the  buildings  of  the  hospital  with 
marvellous  agility.  One  must  take  great  care  to  catch 
him,  and  use  all  sorts  of  cautions  to  get  him  down, 
for  he  wakes  with  a  stupefied  air,  and  as  soon  as  he  is 
awake,  both  his  legs  are  paralyzed  again,  and  he  must  be 
carried  to  his  bed.  He  does  not  understand  what  you 
are  speaking  about,  and  cannot  comprehend  how  it  hap- 
pens that  people  were  obliged  to  go  to  the  top  of  the 
house  in  order  to  look  for  a  poor  man  who  has  been 
paralyzed  in  his  bed  for  months. 

A  fourth  and  last  observation,  for  I  insist  upon  relat- 
ing to  you  a  great  number  of  instructive  examples.  We 
come  back  to  the  common  story  of  a  young  girl  twenty 
years  old,  called  Irene,  whom  despair,  caused  by  her 
mother's  death,  has  made  ill.  We  must  remember  that 
this  woman's  death  has  been  very  moving  and  dramatic. 
The  poor  woman,  who- had  reached  the  last  stage  of 
consumption,  lived  alone  with  her  daughter  in  a  poor 
garret.  Death  came  slowly,  with  suffocation,  blood- 
vomiting,  and  all  its  frightful  procession  of  symptoms. 
The  girl  struggled  hopelessly  against  the  impossible. 
She  watched  her  mother  during  sixty  nights,  working  at 


3<D        The  Major  Symptoms  of  Hysteria 

her  sewing-machine  to  earn  a  few  pennies  necessary  to 
sustain  their  lives.  After  the  mother's  death  she  tried 
to  revive  the  corpse,  to  call  the  breath  back  again ;  then, 
as  she  put  the  limbs  upright,  the  body  fell  to  the  floor, 
and  it  took  infinite  exertion  to  lift  it  again  into  the  bed. 
You  may  picture  to  yourself  all  that  frightful  scene. 
Some1  time  after  the  funeral,  curious  and  impressive 
symptoms  began.  It  was  one  of  the  most  splendid 
cases  of  somnambulism  I  ever  saw. 

The  crises  last  for  hours,  and  they  show  a  splendid 
dramatic  performance,  for  no  actress  could  rehearse 
those  lugubrious  scenes  with  such  perfection.  The 
young  girl  has  the  singular  habit  of  acting  again  all  the 
events  that  took  place  at  her  mother's  death,  without 
forgetting  the  least  detail.  Sometimes  she  only  speaks, 
relating  all  that  happened  with  great  volubility,  put- 
ting questions  and  answers  in  turn,  or  asking  questions 
only,  and  seeming  to  listen  for  the  answer;  sometimes 
she  only  sees  the  sight,  looking  with  frightened  face 
and  staring  on  the  various  scenes,  and  acting  according 
to  what  she  sees.  At  other  times,  she  combines  all 
hallucinations,  words,  and  acts,  and  seems  to  play  a  very 
singular  drama.  When,  in  her  drama,  death  has  taken 
place,  she  carries  on  the  same  idea,  and  makes  every- 
thing ready  for  her  own  suicide.  She  discusses  it 
aloud,  seems  to  speak  with  her  mother,  to  receive  ad- 
vice from  her ;  she  fancies  she  will  try  to  be  run  over  by 
a  locomotive.  That  detail  is  also  a  recollection  of  a 
real  event  of  her  life.  She  fancies  she  is  on  the  way,  and 
stretches  herself  out  on  the  floor  of  the  room,  waiting 
for  death,  with  mingled  dread  and  impatience.  She 


Monoideic  Somnambulisms  31 

poses,  and  wears  on  her  face  expressions  really  worthy 
of  admiration,  which  remain  fixed  during  several 
minutes.  The  train  arrives  before  her  staring  eyes, 
she  utters  a  terrible  shriek,  and  falls  back  motionless, 
as  if  she  were  dead.  She  soon  gets  up  and  begins  acting 
over  again  one  of  the  preceding  scenes.  In  fact,  one 
of  the  characteristics  of  these  somnambulisms  is  that 
they  repeat  themselves  indefinitely.  Not  only  the  dif- 
ferent attacks  are  always  exactly  alike,  repeating  the 
same  movements,  expressions,  and  words,  but  in  the 
course  of  the  same  attack,  when  it  has  lasted  a  certain 
time,  the  same  scene  may  be  repeated  again  exactly 
in  the  same  way  five  or  ten  times.  At  last,  the  agita- 
tion seems  to  wear  out,  the  dream  grows  less  clear,  and, 
gradually  or  suddenly,  according  to  the  cases,  the  patient 
comes  back  to  her  normal  consciousness,  takes  up 
her  ordinary  business,  quite  undisturbed  by  what  has 
happened. 

I  could  tell  you  many  more  of  these  examples,  for  all 
the  events  of  life  may  be  reflected  in  one  of  these  scenes. 
This  patient  acts  over  again  a  scene  wherein  he  has  been 
bitten  by  a  dog ;  that  one  reproduces  in  his  dream  the 
emotion  he  had  when  he  was  wounded  by  the  falling 
of  the  lift.  This  little  girl  fancies  a  scene  of  her  school 
life,  in  which  she  was  severely  punished;  that  young 
girl  reflects  a  scene  of  ravishment ;  a  young  boy  repeats 
a  quarrel  in  the  street ;  another  man  lives  through  a 
chapter  he  has  read  in  a  novel,  where  thieves  get  through 
a  latticed  window  and  bind  him  tightly  to  his  bed.  This 
kind  of  delirium  may  vary  over  and  over  again  in  a 
thousand  different  ways.  It  is,  however,  very  character- 


32        The  Major  Symptoms  of  Hysteria 

istic,  and  in  all  mental  pathology  you  will  not  find 
another  delirium  that  may  be  compared  with  it.  It  is 
then  necessary  to  study  carefully  the  psychological 
character  of  which  it  is  made  up ;  for  the  precise  analy- 
sis of  this  simple  delirium  will  perhaps  be  the  starting- 
point  whence  we  shall  proceed  to  explain  the  other 
more  complicated  states. 

II 

Innumerable  studies  have  been  written  to  analyse 
the  preceding  state  in  every  particular.  I  shall  only 
sum  up  the  very  clear  result  of  those  studies,  and  I 
shall  do  it  by  following  that  state  from  its  starting-point 
to  the  return  of  normal  life.  There  is  a  first  very  im- 
portant period,  but  on  it  we  cannot  yet  dwell;  it  is 
the  moment  when  somnambulism  begins,  the  change 
from  the  normal  to  the  second  state.  When  the  change 
is  sudden,  there  is,  as  it  seems,  a  loss  of  consciousness, 
a  half  faint.  When  the  change  is  slow,  one  may 
easily  observe  the  abasement  of  mental  activity;  the 
patient  pays  no  more  attention  to  exterior  events ;  he 
understands  less  and  less  what  you  tell  him,  and  he  an- 
swers with  difficulty,  is  absent-minded,  works  more 
slowly,  or  interrupts  his  work.  In  short,  voluntary 
activity  and  close  application  seem  to  disappear,  to  give 
place  to  the  expansion  of  the  dream. 

When  the  dream  begins,  you  may  note  a  very  strik- 
ing and  important  characteristic ;  namely,  the  perfection 
and  the  intensity  of  its  development.  All  the  phenom- 
ena in  connection  with  the  dream  seem  enormously 


Monoideic  Somnambulisms  33 

increased.  Undoubtedly  we  all  take  expressions  and 
attitudes  in  connection  with  our  thought,  but  our  ex- 
pressions look  shabby  and  incomplete  in  comparison 
with  the  marvels  of  plasticity  we  may  sometimes  ob- 
serve in  somnambulism.  Some  of  the  patients,  as 
we  have  already  remarked,  neither  speak  nor  move, 
but  remain  fixed  in  an  expressive  attitude.  That  form 
of  monoideic  somnambulism  is  called  catalepsy.  We 
have  no  time  to  dwell  on  all  its  various  forms ;  we  will 
only  point  out  the  perfect  expression  of  those  living 
statues  that  have  often  inspired  superstitious  wonder. 
We  may  learn  by  different  means  what  images  fill 
his  consciousness,  and  we  may  see  that  he  has  not  our 
dull  memory  df  things,  but  that  he  sees  the  objects  he 
speaks  of,  and  really  hears,  feels,  touches  them  exactly 
as  if  they  were  real.  The  unfolding  of  hallucinations  is 
incomparable,  and  except  in  some  crises  of  alcoholic 
delirium,  that  are  a  little  like  hysteria,  we  shall  never 
find  in  lunacy  such  abundance  and  such  copiousness 
in  the  hallucinations  of  all  senses.  When  the  patient 
speaks,  he  has  a  fluency  of  elocution  and  even  an  elo- 
quence that  seems  superior  to  his  normal  powers, 
because  he  gives  himself  entirely  up  to  the  idea  he  means 
to  express.  When  he  acts,  he  has  a  precision  and  quick- 
ness in  his  movements  that  make  a  wonderful  actor  of 
him,  and  here,  again,  he  surpasses  his  usual  powers. 
The  patient  we  just  spoke  of,  the  one  who  believed  he 
was  rescuing  his  child  by  carrying  his  pillow,  ran  on  the 
housetop  with  more  agility  than  he  would  have  shown 
in  his  normal  state,  even  if  he  had  not  been  palsy- 
stricken.  One  of  my  patients  who  does  not  know  how 


34        The  Major  Symptoms  of  Hysteria 

to  write,  writes  during  her  somnambulism.  It  is  no 
wonder,  and  there  is  no  mystery  about  the  case ;  in  the 
somnambulic  state  that  woman  remembered  the  writ- 
ing she  had  learned  at  school,  as  a  child,  and  had  to  all 
appearance  forgotten  thirty  years  ago. 

The  development  of  the  somnambulic  delirium  is  not 
only  intense,  it  is  also  perfectly  regular.  The  patient 
repeats  the  same  words  at  the  same  moments,  makes 
the  same  gestures  at  the  same  place,  every  time  he  be- 
gins his  performance  over  again.  He  seems  to  have  on 
that  point  a  marvellous  memory;  when  he  has  appro- 
priated his  somnambulism  to  a  given  room,  he  remem- 
bers all  that  he  did  at  each  different  spot ;  he  knows 
from  what  drawer  he  took  the  photos  he  pretends  to 
eat  up,  in  what  table  he  found  a  bit  of  wood  that  he 
used  as  a  pistol;  he  goes  directly  to  that  spot,  unhesi- 
tating, knowing  exactly  what  he  expects  to  find  there. 
Sometimes,  in  the  course  of  various  somnambulisms, 
the  patient,  instead  of  beginning  his  history  over  again, 
takes  up  his  delirium  at  the  exact  point  where  he  last 
stopped,  and  seems  to  remember  perfectly  at  what 
point  he  broke  off  in  his  last  delirium.  You  recollect 
one  of  Charcot's  somnambulists  who  believed  himself 
a  journalist  and  who  wrote  a  novel;  he  waked  after 
writing  two  or  three  pages,  which  were  taken  away  from 
him.  In  the  next  crisis,  he  began  his  novel  exactly  at 
the  point  where  he  had  broken  off.  You  see  what  an 
important  part  regularity  and  memory  play  in  these 
scenes.  Inversely,  the  patient's  liberty  or  power  of 
will  seem  to  have  no  share  in  these  crises,  for  the  scene 
is  never  altered  in  the  way  the  patient  could  wish. 


Monoideic  Somnambulisms  35 

This  negative  character  will  become  even  more  striking 
if  we  study  somnambulism  from  another  point  of  view. 

In  contrast  with  the  brilliant  unfolding  of  some 
phenomena,  we  discover  with  amazement  strange 
mental  blanks.  The  same  patient  who  looks  as  if  he 
had  very  precise  sensations,  since  he  can  walk  on  the 
house's  top,  look  for  objects  in  a  drawer,  and  see  very 
clearly  the  bed  where,  in  his  fancy,  his  mother  lies  dying, 
—  this  same  patient  seems  unable  to  grasp  anything  else. 
This  is  what  first  struck  popular  observation.  Speak 
to  them  and  they  do  not  answer;  try  by  all  sorts  of 
means  to  make  your  presence  felt,  they  do  not  seem  to 
feel  it.  The  objects  you  thrust  before  their  eyes  do  not 
in  the  least  alter  their  dream,  and  do  not  in  the  least 
stop  it ;  as  the  doctor  remarks  in  the  case  of  Lady  Mac- 
beth, their  eyes  seem  open,  but  they  are  shut  to  all  im- 
pressions that  are  not  connected  with  their  dream. 
To  make  yourself  heard,  you  must  dream  with  the 
patient  and  speak  to  him  only  words  in  accordance  with 
his  delirium. 

As  the  patient  perceives  nothing  except  the  idea  he 
is  possessed  of,  he  remembers  nothing  except  that  one 
idea.  He  knows  not  where  he  is ;  he  has  quite  forgotten 
the  changes  that  have  taken  place  since  the  time  he 
speaks  of;  he  often  does  not  even  know  his  name. 
His  memory,  as  well^as  his  sensations,  is  shut  up  hi  a 
narrow  circle. 

The  somnambulism  is  ended ;  the  patient  comes  back 
to  consciousness.  We  may  then  notice  new  characteris- 
tics and  see  how  they  add  themselves  to  the  preceding 
ones.  The  patient  resumes  his  former  sensations;  the 


36        The  Major  Symptoms  of  Hysteria 

memory  he  has  lost  comes  back,  he  knows  his  name, 
knows  also  where  he  is,  and  remembers  all  the  events  of 
his  life ;  he  has,  to  all  appearance,  his  former  character 
and  personality;  but  the  wonderful  thing  is,  that,  in 
this  new  personality,  somnambulism  has  left  a  gap. 
He  appears  to  have  forgotten  all  that  preceding  period 
that  amazed  us  to  such  a  point  by  its  dramatic  character. 
He  is  not  disturbed  by  it;  he  does  not  endeavour  to 
apologize  for  the  ridiculous  acts  he  has  just  accomplished ; 
he  wonders  sometimes  at  the  untidiness  of  the  room, 
of  which  he  is  himself  the  cause,  and  cannot  understand 
how  it  came  about.  If  you  question  him,  try  to  awaken 
his  memory  by  direct  questions,  either  of  two  things  may 
happen.  In  describing  with  too  much  accuracy  what 
the  patient  has  just  done  in  his  delirium,  you  will  either 
revive  his  memory  so  vividly  that  he  will  fall  back  again 
into  the  preceding  state,  be  wholly  taken  up  by  that 
recollection,  forget  that  you  are  there  and  act  the  whole 
scene  over  again ;  or,  as  more  frequently  happens,  you 
will  be  unable  to  recall  to  his  mind  the  lost  memory. 
He  does  not  understand  what  you  mean.  All  the  pre- 
ceding scene  which  hi  reality  is  so  lively  and  persistent 
in  his  memory,  since  it  will  begin  over  again,  or  will 
enter  in  the  next  crisis,  seems  at  that  moment  quite  out 
of  his  consciousness.  These  are  the  chief  psychological 
characteristics  that  come  out  in  somnambulism.  Dur- 
ing the  crisis  itself,  two  opposite  characteristics  manifest 
themselves;  first,  a  huge  unfolding  of  all  the  phe- 
nomena connected  with  a  certain  delirium ;  second,  an 
absence  of  every  sensation  and  every  memory  that  is  not 
connected  with  that  delirium.  After  the  crisis,  during 


Monoideic  Somnambulisms  37 

the  state  that  appears  as  normal,  two  other  character- 
istics appear,  opposite,  to  all  appearance :  the  return  of 
consciousness  of  sensations  and  normal  memory,  and 
the  entire  forgetfulness  of  all  that  is  connected  with  the 
somnambulism.  Let  us  remember  all  these  notions 
that  here  seem  very  simple,  and  we  shall  afterwards  see 
them  unfolded  in  every  hysterical  phenomenon. 

Ill 

The  facts  and  the  laws  of  somnambulism  we  have 
just  described  have  been  well  known  for  a  longtime,  and 
usually  they  made  up  all  that  was  studied  about  this 
curious  state.  But  I  believe  that  we  must  notice  an- 
other interesting  fact  in  order  to  understand  better  the 
whole  of  the  monoideic  somnambulism.  This  fact  is 
usually  more  or  less  concealed,  but  it  becomes  very 
apparent  and  conspicuous  in  certain  cases. 

Let  us  take  up  the  case  of  that  young  girl,  Irene,1 
who  acts  during  her  somnambulism  the  scene  of  her 
mother's  death  with  such  apparent  precision.  Let 
us  watch  her  during  the  intervals  of  her  fits,  during  the 
period  in  which  she  seems  to  be  normal ;  we  shall  soon 
notice  that  even  at  that  time  she  is  different  from  what 
she  was  before.  Her  relatives,  when  she  was  conveyed 
to  the  hospital,  said  to  us :  "She  has  grown  callous  and 
insensible,  she  has  soon  forgotten  her  mother's  death, 
and  does  not  seem  to  remember  her  illness."  That 
remark  seems  amazing;  it  is,  however,  true  that  this 

1  Cf.  "L'amn^sie  et  la  dissociation  des  souvenirs  par  l'£motion," 
Journal  de  psychologic  normale  et  pathologique,  1904,  p.  417. 


38        The  Major  Symptoms  of  Hysteria 

young  girl  is  unable  to  tell  us  what  brought  about  her 
illness,  for  the  good  reason  that  she  has  quite  forgotten 
the  dramatic  event  that  happened  three  months  ago. 
"I  know  very  well  my  mother  must  be  dead,"  she  says, 
"  since  I  have  been  told  so  several  times,  since  I  see  her 
no  more,  and  since  I  am  in  mourning ;  but  I  really  feel 
astonished  at  it.  When  did  she  die?  What  did  she 
die  from  ?  Was  I  not  by  her  to  take  care  of  her  ?  There 
is  something  I  do  not  understand.  Why,  loving  her  as  I 
did,  do  I  not  feel  more  sorrow  for  her  death  ?  I  can't 
grieve ;  I  feel  as  if  her  absence  was  nothing  to  me,  as  if 
she  were  travelling,  and  would  soon  come  back."  The 
same  thing  happens  if  you  put  to  her  questions  about 
any  of  the  events  that  happened  during  those  three 
months  before  her  mother's  death.  If  you  ask  her 
about  the  illness,  the  mishaps,  the  nightly  staying  up, 
anxieties  about  money,  the  quarrels  with  her  drunken 
father,  —  all  these  things  have  quite  vanished  from  her 
mind.  If  we  had  had  time  to  dwell  upon  that  case,  we 
should  have  seen  these  many  curious  instances :  the 
filial  love,  the  feeling  of  affection  she  had  felt  for  her 
mother,  have  quite  vanished.  It  looks  as  if  there  was  a 
gap  as  well  in  the  feelings  as  in  the  memory.  But  I 
shall  insist  only  on  one  point :  the  loss  of  memory 
bears  not  only,  as  is  generally  believed,  on  the  period  of 
somnambulism,  on  the  scene  of  delirium;  the  loss  of 
memory  bears  also  on  the  event  that  has  given  birth 
to  that  delirium,  on  all  the  facts  that  are  connected  with 
it,  on  the  feelings  that  are  related  to  it. 

This  very  important  remark  may  be  extended  to  all 
the  other  cases  I  have  related.    He.,  who  has  the  de- 


Monoideic  Somnambulisms  39 

lirium  in  which  she  fancies  herself  a  lioness,  has  not 
only  forgotten  this  period  of  somnambulism,  but  also  the 
walk  in  the  zoological  garden,  that  first  cause  of  her 
delirium.  Sm.,  who  carries  his  pillow  on  the  house- 
top, believing  that  he  is  rescuing  his  child  from  the 
clutches  of  his  mother-in-law,  does  not  remember  his 
quarrels  with  that  woman,  although  those  quarrels  were 
the  starting-point  of  the  actual  disease. 

I  have  noted  down  in  this  connection  a  very  singular 
observation,  in  which  this  retrograde  amnesia  accom- 
panying somnambulism  is  well  brought  into  evidence.1  A 
young  girl,  nineteen  years  old,  Lie.,  has  fits  of  somnam- 
bulism in  which  she  speaks  about  thieves,  about  a  fire, 
and  calls  to  her  help  a  certain  Lucien.  When  awakened, 
she  knows  nothing  about  all  this,  and  when  you  speak  to 
her  of  what  she  said,  she  pretends  that  in  her  life  there 
is  no  event  in  which  any  part  was  played  by  thieves, 
by  a  fire,  or  by  Lucien.  As  she  had  come  alone  to  the 
hospital,  we  had  no  other  information,  and  were  com- 
pelled to  believe  that  she  had  an  imaginary  delirium. 
Six  months  afterwards  only,  some  relatives  of  hers, 
who  had  come  from  the  country  to  see  her,  told  us  of 
an  event  that  happened  three  years  before,  and  was  the 
starting-point  of  her  nervous  crises.  She  was  a  servant 
in  a  country  seat  which  one  night  was  robbed  and  set 
on  fire  by  thieves,  and  she  was  rescued  by  a  gardener 
called  Lucien.  It  is  astonishing  that  this  young  girl 
could  have  utterly  forgotten  such  an  important  event, 
and  that  she  was  never  able  to  speak  about  it  when  she 

1  Cf .  "  N^vroses  et  Idees  fixes,"  1898,  Vol.  II,  observation  69, 
p.  234. 


40        The  Major  Symptoms  of  Hysteria 

related  to  the  physician  the  story  of  her  life  and  the  be- 
ginning of  the  disease.  It  is  worthy  of  note  that  the 
forgetfulness  of  this  fact  coincides  with  the  development 
of  that  extraordinary  memory  on  the  same  subject  that 
filled  her  somnambulism. 

Without  any  doubt  the  forgetfulness  of  the  idea  which 
plays  the  greatest  part  in  the  monoideic  somnambulism 
is  not  always  so  clear,  so  perfect.  But  I  believe  this 
forgetfulness  always  exists  more  or  less  concealed,  and 
the  profundity  of  the  forgetfulness  is  in  proportion  to  the 
depth,  the  serious  nature  of  the  somnambulism  itself. 
According  to  my  belief,  the  somnambulism  is  followed 
by  an  amnesia  which  is  retrograde,  and  bears  not  only 
on  the  somnambulism  itself,  but  also  on  all  the  facts, 
the  memories  related  to  it.  I  beg  the  observers  who 
can  study  such  cases  of  somnambulism  to  notice  with 
great,  care  these  troubles  of  memory  added  to  the 
disease. 

How  can  we  understand,  how  can  we  picture  to  our- 
selves the  whole  of  these  facts?  What  is  the  essential 
point  which  can  sum  up  the  observations?  I  propose 
to  you  the  following  psychological  interpretation.  An 
idea,  the  memory  of  an  event,  for  instance,  the  thought 
of  a  ferocious  animal,  the  thought  of  a  mother's  death, 
—  all  these  form  groups  of  psychological  facts  closely 
connected  with  one  another;  they  are  certain  kinds  of 
systems  comprising  all  sorts  of  pictures  and  all  sorts 
of  tendencies  to  certain  movements,  but  with  a  strong 
unity.  These  systems  in  our  minds  have"  their  strength 
and  their  law  of  development  that  are  peculiar  to  them. 
They  have  also  a  great  tendency  to  development 


Monoideic  Somnambulisms  41 

when   they  are   not  kept  within  bounds  by  another 
power.1 

Allow  me  to  represent  to  you  this  system  of  psycho- 
logical facts,  which  constitutes  an  idea,  by  a  system  of 
points  connected  together  by  some  lines,  forming  a  sort 


FIG.  i. 

of  polygon  (Fig.  i).  The  point  S  represents  the  sight 
of  the  face  of  the  dead  mother,  the  point  V  is  the  sound 
of  her  voice;  another  point,  M,  is  the  feeling  of  the 
movements  made  to  carry  up  the  body,  and  so  on. 
This  polygon  is  like  the  system  of  thoughts  which  was 

1  See  these  laws  of  development  of  the  mental  systems  in  my  first 
book,  "  L'automatisme  psychologique,"  1889. 


42        The  Major  Symptoms  of  Hysteria 

developed  in  the  mind  and  in  the  brain  of  our  patient 
Irene.  Each  point  is  connected  with  the  others,  so 
one  cannot  excite  the  first  without  giving  birth  to  the 
second,  and  the  entire  system  has  a  tendency  to  develop 
itself  to  the  utmost. 

But  at  the  same  time  in  healthy  minds  these  systems 
pertaining  to  each  idea  are  connected  with  an  infinitely 
wider  system  of  which  they  are  only  a  part,  —  the  system 
of  our  entire  consciousness,  of  our  entire  individuality. 
The  remembrance  of  the  mother's  death,  even  the 
affection  Irene  feels  for  her  mother,  with  all  the  memo- 
ries that  are  connected  with  it,  forms  only  a  part  of  the 
whole  consciousness  of  the  young  girl  with  all  its  memo- 
ries and  other  tendencies.  Let  this  large  circle,  P,  near 
the  little  polygon  represent  the  whole  personality  of  the 
girl,  the  memory  of  all  that  happened  in  her  previous 
life. 

Normally,  in  good  health,  the  little  system  must  be 
connected  with  the  large  one,  and  must  in  great  part 
depend  on  it.  Generally  the  partial  system  remains 
subject  to  the  laws  of  the  total  system :  it  is  called  up 
only  when  the  whole  consciousness  is  willing,  and  within 
the  limits  in  which  this  consciousness  allows  it. 

Now,  to  picture  to  ourselves  what  has  taken  place 
during  somnambulism,  we  may  adopt  a  simple  provi- 
sional resume.  Things  happen  as  if  an  idea,  a  partial 
system  of  thoughts,  emancipated  itself,  became  inde- 
pendent and  developed  itself  on  its  own  account.  The 
result  is,  on  one  hand,  that  it  develops  far  too  much, 
and,  on  the  other  hand,  that  consciousness  appears  no 
longer  to  control  it.  That  general  remark  may  still 


Monoideic  Somnambulisms  43 

seem  to  you  very  vague  and  very  difficult  to  understand. 
Nevertheless,  I  wished  to  point  it  out  to  you  in  a  few 
words :  first,  because  it  emerges  very  clearly  out  of  the 
study  of  the  first  phenomenon  of  hysteria ;  secondly, 
because  it  will  serve  us  as  a  clew  to  understand  a  thou- 
sand other  cases  of  the  neurosis.  Don't  trouble  about 
the  obscurity  of  that  first  remark;  after  you  have 
repeated  it  exactly  in  the  same  way  with  regard  to  a 
thousand  different  phenomena,  it  will  not  be  long  before 
you  find  yourself  understanding  it  clearly. 


LECTURE  III 
FUGUES  AND  POLYIDEIC  SOMNAMBULISMS 

Transformations  and  exaggerations  of  the  first  somnambu- 
lisms—  Several  cases  of  fugues  —  The  laws  of  fugues  — 
The  diagnosis  of  hysterical  fugues  —  Differences  between 
fugues  and  monoideic  somnambulisms —  The  characters  of 
polyideic  somnambulisms  and  their  relations  to  the  simpler 
forms  —  The  emancipation  of  feelings  and  emotions 

A  GREAT  many  hysteric  accidents  are  directly  con- 
nected with  the  kind  of  somnambulism  we  have  just 
studied.  They  are  only  slight  transformations  of  the 
same  phenomenon.  Sometimes  somnambulism  in- 
creases, develops  in  a  particular  direction,  sometimes 
it  diminishes,  keeps  back  only  a  few  symptoms,  and 
it  is  sometimes  difficult  to  know  it  again.  But  the 
phenomena  are  still  of  the  same  kind ;  they  must  be  ex- 
plained in  the  same  manner,  and,  if  we  wish  to  under- 
stand hysteria  well,  it  is  very  important  we  should  know 
the  possible  transformations  of  that  fundamental  state 
of  somnambulism.  To-day,  and  in  our  next  lecture,  we 
shall  study  the  exaggerations  and  developments  that 
multiply  to  a  very  high  degree  our  first  monoideic  som- 
nambulism. The  first  fact  we  meet  with,  in  this  di- 
rection, is  one  of  the  most  wonderful  phenomena  of 
hysteria,  the  study  of  which  has  already  attracted  many 
authors.  This  fact  is  the  hysterical  mania  of  running 

44 


Fugues  and  Polyideic  Somnambulisms     45 

away  that  we  call  ambulatory  automatism,  flights,  or 
better,  fugues,  if  we  may  keep  the  French  word. 


We  shall  begin,  as  we  are  wont  to,  by  showing  you  a 
certain  number  of  clinical  cases,  as  if  the  patients  were 
here  before  your  eyes.  We  shall  thus  more  easily 
acquire  the  knowledge  of  the  clinical  characters  and  of 
the  general  idea  that  is  to  be  derived  from  them. 

Here  is  a  splendid  case  of  hysterical  fugue,  remarkable 
for  its  simplicity.  You  can  find  the  entire  description 
of  it  in  the  Gazette  des  Hopitaux,  where  I  published  it 
with  Professor  Raymond  on  the  second  of  July,  1895. 
The  subject  is  a  man,  P.,  thirty  years  old,  employed  hi 
a  railway  station  in  a  town  in  the  east  of  France. 
Although  an  active  and  clever  fellow,  he  was  a  little 
eccentric,  and  had  already  led  a  somewhat  adventurous 
life.  In  his  youth  he  had  had  frequent  fits  of  somnam- 
bulism, sometimes  in  the  day,  but  mostly  at  night. 
Moreover,  the  tendency  to  somnambulisms  is  to  be 
found  in  his  family,  since  his  brother  was  also  a  noctur- 
nal somnambulist,  who  got  out  of  his  bed  while  asleep 
to  work  at  his  exercises.  One  day,  like  a  patient  we 
have  spoken  of,  he  carried  his  pillow  on  the  housetop, 
mistaking  it  for  a  little  baby.  If  I  dwell  upon  these  pre- 
vious somnambulisms  similar  to  those  we  have  already 
described,  it  is  because  they  form  a  link  between  the 
first  phenomena  we  have  spoken  of  and  those  we  shall 
describe  to-day.  This  man,  P.,  was  also  very  easily 
affected,  predisposed  to  fixed  ideas.  One  day,  in  the 


46        The  Major  Symptoms  of  Hysteria 

notary's  office  where  he  worked,  he  was  slightly  suspected, 
though  not  accused,  of  stealing  a  trifle.  He  fell  ill,  and 
was  very  distressed.  Night  and  day  he  discussed  that 
suspicion,  and,  although  everybody  tried  to  prove  to 
him  how  trifling  it  was,  he  could  not  remain  in  that 
office.  Moreover,  he  had  a  tendency  to  exaggerated 
fears.  He  had  left  Lorraine  after  its  annexation  to 
Germany,  and  during  many  years  he  was  haunted  by 
the  fear  of  the  German  police,  whom  he  always  believed 
to  be  running  after  him.  All  those  details  have  their 
importance:  you  must  not  forget  thus  to  inquire  into 
the  previous  character  of  your  patients;  such  an  in- 
quiry will  often  enable  you  to  understand  very  well  the 
neuropathic  diseases  that  come  on  later.  However 
that  may  be,  the  man  we  are  talking  of  had  also  an  ad- 
venturous turn  of  mind.  He  started  with  the  Crevaux 
mission  on  an  expedition  to  South  Africa,  and  was  sent 
back  to  France  on  account  of  his  health.  Then  he 
enlisted  under  the  orders  of  De  Brazza,  who  was  starting 
for  Gabon.  There,  we  must  also  notice,  he  was  very 
much  debilitated  by  diseases  peculiar  to  hot  climates, 
and  continued  long  after  his  return  to  have  fits  of  the 
ague.  This  also  is  serious  enough  to  prepare  the  way 
for  the  ensuing  mental  weakness. 

On  his  return  to  France,  at  the  age  of  twenty,  he  got 
a  situation  in  a  railway  company,  and  was  soon  in  easy 
circumstances.  He  married,  and  had  a  child  he  dearly 
loved.  His  wife  was  again  pregnant  when  the  following 
incident  took  place.  Although  he  led  a  quiet  and 
rather  happy  life,  he  was  uneasy  in  his  mind,  and  gave 
himself  up  to  intellectual  labours  too  hard  for  a  man 


Fugues  and  Polyideic  Somnambulisms     47 

who  had  no  great  acquirements.  To  his  work  in  the 
railway  office  he  added  bookkeeping  and,  what  is  more, 
he  drew  up  a  geographical  account  of  Gabon  from  the 
notes  he  had  taken,  and  this  work  gave  him  much 
trouble.  He  was  made  uneasy  in  his  mind  by  family 
quarrels :  his  brother,  who  was  jealous  of  him,  had  just 
quarrelled  with  him  and  had  charged  him  with  shameful 
and  dishonest  acts.  The  charge  was  groundless,  and 
nobody  around  him  troubled  about  it,  but  we  know  how 
easily  upset,  how  susceptible  he  was  in  that  quarter,  and 
how  he  lost  his  head  at  the  mere  idea  of  a  charge  of 
that  kind. 

It  is  in  these  conditions  that  we  come  to  the  third  of 
February,  1895.  He  was  alone  at  Nancy,  his  wife 
having  left  him  for  a  few  days.  He  had  just  ended  a 
chapter  of  his  work  on  Gabon,  and,  to  take  a  little  rest, 
he  went  to  a  coffee-house  where  he  was  well  known. 
During  the  afternoon,  a  part  of  which  he  spent  with 
some  friends  at  this  coffee-house  in  playing  billiards, 
he  drank  a  cup  of  coffee,  two  glasses  of  beer,  and  a 
small  glass  of  vermouth  which  the  coffee-house  keeper 
wished  him  to  taste.  He  told  us  himself  all  these  cir- 
cumstances, which  he  remembers  quite  well.  He  also 
knows  that  one  of  his  neighbours  came  to  the  coffee- 
house and  invited  him  to  dinner,  as  he  was  alone  at 
home.  He  accepted  the  invitation.  So  everything  was 
as  it  should  be,  and  he  has  a  very  exact  memory  of  all 
that  happened  then.  He  left  that  coffee-house  about 
five,  ready  to  go  and  dine  with  his  friend;  but  a  few 
yards  off,  while  crossing  the  Stanislas  bridge  over  the 
railway  line,  just  as  he  got  to  the  middle  (that  also  he 


48        The  Major  Symptoms  of  Hysteria 

perfectly  remembers),  he  felt  a  violent  pain  in  his  head, 
as  if  he  had  been  struck  on  the  posterior  part  of  his  head. 
I  point  out  these  sensations  to  you  without  being  able 
to  dwell  on  them,  for  they  have  not  as  yet  been  suffi- 
ciently accounted  for.  But  it  is  necessary  you  should 
know  they  often  occur  in  the  same  conditions  with 
neuropathic  patients.  The  blow  in  the  occiput  is  very 
often  characteristic  of  great  fits,  of  great  changes  of 
personality.  It  is  just  what  happened  in  this  case, 
for  immediately  after  that  something  must  have 
changed  in  the  mental  state  of  our  patient,  as  he  has 
entirely  lost  the  memory  of  all  that  happened  after- 
wards on  that  Sunday,  the  third  of  February,  1895, 
and  on  the  following  days. 

When  he  comes  back  to  consciousness,  or  rather 
when  he  resumes  the  thread  of  his  recollections,  the 
circumstances  are  changed  to  an  extravagant  degree. 
His  first  recollection  is  the  following :  he  was  lying  in  a 
field,  covered  with  snow,  half  dead,  and  amazed  to  find 
himself  in  that  place ;  he  got  up  painfully,  found  a  road 
with  a  tramway  line,  walked  along  that  line,  and  finally 
got,  not  without  difficulty,  to  a  town  quite  unknown 
to  him,  near  a  railway  station.  It  was  the  South  Station 
at  Brussels.  It  was  eleven  o'clock  in  the  evening,  and 
the  date  he  read  in  a  newspaper  was  the  twelfth  of 
February.  In  short,  he  had  felt  a  shock  on  the  head 
at  Nancy  on  the  third  of  February,  and  awoke  in  the 
neighbourhood  of  Brussels  on  the  twelfth.  All  that  had 
happened  in  the  meantime,  how  he  accomplished  that 
singular  journey,  he  does  not  in  the  least  know. 

He  telegraphed  to  ask  for  assistance:  he  was  taken 


Fugues  and  Polyideic  Somnambulisms     49 

care  of  and  conveyed  to  Paris  to  the  Salpe'triere,  where 
we  studied  his  case.  I  will  not  now  explain  to  you  how 
we  revived  his  recollections ;  it  would  imply  notions  on 
hysteria  that  you  have  not  yet  acquired.  I  shall  only 
tell  you  that  we  contrived  to  know  what  happened  during 
those  nine  days,  and  that  we  may  now  add  it  to  the  story 
of  his  fugue. 

On  the  Stanislas  bridge,  after  he  had  felt  the  blow  on 
the  head,  he  felt  himself  overwhelmed  with  fear  at  the 
thought  of  the  charge  brought  against  him  by  his 
brother,  so  that  he  went  home  in  great  anxiety.  A  few 
slight  occurrences,  too  long  to  tell,  increased  the  feeling 
of  guilt,  and  in  the  evening,  which  he  spent  in  wandering 
about  the  streets  without  going  to  his  neighbour's  for 
dinner,  he  constantly  pondered  on  the  way  to  escape 
those  accusations  and  on  the  means  of  running  away. 
He  returned  home,  where  he  took  some  money,  and  went 
to  sleep  in  an  hotel  in  the  suburbs  instead  of  remaining 
quietly  at  home.  He  rose  early,  and  avoiding  the  rail- 
way, went  on  foot  through  the  fields  to  Champigneul. 
When  he  had  arrived  there  he  went  to  the  railway 
station,  where  he  was  not  known,  and  took  a  ticket  for 
Pagny  on  the  Moselle;  from  Pagny  he  walked  to 
Longwy,  still  avoiding  with  the  greatest  care  the  per- 
sons who,  he  fancied,  were  running  after  him.  And  in 
fact  he  did  avoid  them  very  well,  for  his  disappearance 
had  been  noticed,  and  he  was  sought  after  with  great 
anxiety.  At  Longwy  he  took  the  train  to  Luxemburg, 
then  to  Arlon  and  to  Brussels,  still*  with  the  rooted  idea 
of  taking  refuge  in  a  foreign  country  under  a  false  name, 
in  order  to  escape  pursuit.  At  Brussels,  he  first  went 


50        The  Major  Symptoms  of  Hysteria 

to  a  good  hotel  and  spent  his  days  in  seeking  the  means 
of  earning  a  few  pence.  But  he  did  not  succeed,  and 
his  small  means  dwindled  away.  He  took  lodgings  in 
a  very  shabby  room,  then  in  one  of  those  asylums  where 
poor  people  are  lodged  at  night.  There  a  good  man  had 
pity  on  him  and  gave  him  a  letter  of  introduction  to  a 
charitable  foundation.  That  letter  played  afterwards 
an  important  part,  for  he  found  it  again  in  his  pocket 
after  waking  up,  and  it  enabled  him,  at  the  time  of  his 
recovery,  to  retrace  the  former  events  and  to  recollect 
what  had  happened.  But  on  the  day  it  was  given  to 
him  he  did  not  use  it,  so  that  he  fell  into  the  most 
terrible  poverty.  He  was  on  the  point  of  enlisting  for 
the  Dutch  Indies ;  but,  happily,  he  was  not  accepted. 
Fancy  that  unhappy  man  in  the  midst  of  a  crisis  of 
somnambulism  sailing  for  India.  Exhausted  with 
fatigue  and  want  of  food,  he  stretched  himself  on  the 
snow  in  the  fields  with  the  vague  idea  that  he  was  about 
to  die. 

Here  something  very  extraordinary  happened,  some- 
thing very  interesting  as  a  psychological  fact.  As  he 
thought  he  was  at  the  point  of  death,  he  could  not  help 
changing  the  bent  of  his  thoughts,  and  in  spite  of  him- 
self, he  thought  that  he  would  like  to  see  his  family 
before  he  died,  stretched  out  in  the  snow.  You  must 
notice  that  the  thought  of  his  family  had  never  entered 
his  mind  during  the  last  days.  The  appearance  of  this 
idea  had  an  unexpected  result.  He  immediately  said 
to  himself,  "But,  after  all,  why  am  I  dying  here,  far 
from  my  family?"  He  got  up;  he  was  awake:  you 
know  what  happened  afterwards.  I  want  only  to  point 


Fugues  and  Polyideic  Somnambulisms     51 

out  to  you  that  enormous  change  in  the  mental  state 
brought  about  by  an  idea. 

The  fact  is  so  interesting,  that  we  must  observe  it  a 
second  time  in  another  case  I  have  studied;  it  is  also 
a  very  strange  one.  I  will  only  sum  up  the  more 
important  facts.  If  you  care  to  read  this  entertaining 
observation,  you  will  find  it  at  full  length  in  the  second 
volume  of  my  work  on  neuroses  and  fixed  ideas.1  Here 
I  shall  only  state  the  facts  that  are  interesting  for  us 
to-day. 

The  subject  is  a  boy  of  seventeen,  Rou.,  son  of  a 
neuropathic  mother,  rather  nervous  himself,  who  already 
had,  when  he  was  ten  years  old,  tics  and  contractures 
in  the  neck,  of  which  we  shall  speak  in  one  of  our  fol- 
lowing lectures.  At  thirteen  he  often  went  to  a  small 
public  house,  visited  by  old  sailors.  They  would  urge 
him  to  drink,  and,  when  he  was  somewhat  flustered, 
they  would  fill  his  imagination  with  beautiful  tales  in 
which  deserts,  palm  trees,  lions,  camels,  and  negroes 
were  pictured  in  a  most  wonderful  and  alluring  way. 
The  young  boy  was  very  much  struck  by  those  pictures, 
particularly  as  he  was  half  tipsy.  However,  when  his 
drunkenness  was  over,  the  stories  seemed  to  be  quite 
forgotten ;  he  never  spoke  of  travels,  and,  on  the  con- 
trary, led  a  very  sedentary  life,  for  he  had  chosen  the 
placid  occupation  of  a  grocer's  boy,  and  he  only  sought 
to  rise  in  that  honourable  career. 

Now  there  come  on  quite  unforeseen  accidents, 
almost  always  on  the  occasion  of  some  fatigue  or  a  fit 
of  drunkenness.  He  then  felt  transformed,  forgot  to 
1  "  Necroses  et  Idees  fixes,"  II,  p.  256. 


52        The  Major  Symptoms  of  Hysteria 

return  home,  and  thought  no  more  of  his  family.  He 
would  leave  Paris,  walking  straight  ahead,  and  go  to  a 
more  or  less  great  distance  through  the  forest  of  St. 
Germain,  or  as  far  as  the  department  of  the  Orne. 
Sometimes  he  walked  alone ;  at  other  times  he  rambled 
with  some  tramps,  begging  along  the  roads ;  he  had  but 
one  idea  left  in  his  head ;  namely,  to  get  to  the  sea,  enlist 
in  a  ship  and  sail  away  towards  those  enchanting  coun- 
tries of  Africa.  His  journeys  ended  rather  badly;  he 
would  awake  suddenly,  drenched,  half  starving,  either 
on  the  highroad  or  in  an  asylum,  without  ever  being 
able  to  understand  what  had  happened,  without  any 
memory  of  his  journey,  and  with  the  most  ardent  wish 
to  go  back  to  his  family  and  his  grocery. 

I  will  dwell  on  only  one  of  his  fugues,  which  is  par- 
ticularly amusing,  and  was  of  extraordinary  duration,  for 
it  lasted  three  months.  He  had  left  Paris  about  the 
fifteenth  of  May,  and  had  walked  to  the  neighbourhood 
of  Melun.  This  time  he  was  thinking  about  the  means 
of  succeeding  in  his  scheme  and  of  getting  safely  to  the 
Mediterranean.  Until  then  he  had  failed,  owing  to 
fatigue  and  misery :  the  question  was  to  find  means  of 
living  as  he  went  along.  A  bright  idea  had  occurred 
to  him ;  not  far  from  Melun,  at  Moret,  there  are  canals 
that  go  more  or  less  straight  to  the  south  of  France,  and 
in  those  canals  there  are  ships  laden  with  goods.  He 
succeeded  in  being  accepted  as  a  servant  on  a  ship 
laden  with  coal.  His  work  was  terrible ;  now  he  had  to 
shovel  the  coal,  now  to  haul  the  rope  in  company  with 
a  donkey  called  Cadet,  his  only  friend.  He  was  badly 
fed,  often  beaten,  exhausted  with  fatigue,  but,  though 


Fugues  and  Polyideic  Somnambulisms     53 

you  would  scarcely  believe  it,  he  was  radiant  with  hap- 
piness. He  thought  only  of  one  thing,  —  of  the  joy  of 
drawing  nearer  to  the  sea.  Unhappily,  in  Auvergne, 
the  boat  stopped,  and  he  was  forced  to  leave  it  and 
continue  his  journey  on  foot,  which  was  more  difficult. 
In  order  not  to  be  resourceless,  he  hired  himself  as  a 
helper  to  an  old  china  mender.  They  went  slowly 
along,  working  on  the  road. 

Then,  one  evening,  an  unlooked-for  event  took 
place  again.  The  day's'  work  had  been  a  success; 
the  two  companions  had  earned  seven  francs.  The 
old  china  mender  stopped  and  said  to  R.,  "My  boy, 
we  deserve  a  good  supper;  and  we  will  keep  to-day's 
feast;  it  is  the  fifteenth  of  August."  On  hearing 
this,  the  boy  heedlessly  said:  "The  fifteenth  of 
August  ?  Why,  it  is  the  feast  of  the  Virgin  Mary, 
the  anniversary  of  my  mother's  name-day."  He 
had  scarcely  uttered  these  words  when  he  appeared  to 
be  quite  changed.  He  looked  all  around  him  with 
astonishment,  and  turning  to  his  companion,  said, 
"But  who  are  you,  and  what  am  I  doing  here  with  you  ?  " 
The  poor  man  was  amazed,  and  was  quite  unable  to 
make  the  boy  understand  the  situation;  the  latter 
still  believed  himself  in  Paris,  and  had  lost  all  memory 
of  the  preceding  months.  They  had  to  go  to  the 
village  mayor's,  where,  with  great  difficulty,  the  matter 
was  made  more  or  less  clear.  The  mayor  telegraphed 
to  Paris,  and  the  prodigal  child  was  sent  back  home. 
Is  not  that  name,  which  suddenly  evoked  the  memory 
of  his  mother  and  awakened  him  likewise,  a  pretty 
conclusion  of  a  fugue  ? 


54        The  Major  Symptoms  of  Hysteria 

The  same  particular  is  to  be  found  in  this  final 
observation,  which  I  will  relate  in  a  few  words.  A 
young  man  of  twenty-nine,  a  clerk  at  a  notary's  office, 
had  made  a  fugue  of  the  same  kind  as  the  preced- 
ing ones,  and  impelled  by  a  fixed  idea,  had  gone  as 
far  as  Algeria.  He  found  himself  at  Oran,  sitting  on  the 
terrace  of  a  coffee-house,  quietly  reading  his  newspaper, 
when  his  eyes  fell  on  a  singular  piece  of  news.  The 
newspaper  related  the  story  of  the  sudden  disappearance . 
of  a  young  notary's  clerk,  aged  twenty-nine,  of  such  a 
name,  and  wondered  what  had  become  of  him.  "  Why," 
thought  the  young  man;  quite  amazed,  "I  am  that 
young  man ;  what  can  have  happened  ?  "  And  he  awoke 
without  remembering  his  freak  in  the  least.  You  see 
that  the  three  observations  are  very  much  alike.  It  was 
formerly  thought  that  such  cases  were  very  rare,  and 
that  they  each  had  particular  characters.  In  reality 
it  is  not  so,  and  we  could  easily  collect  twenty  very 
typical  instances  quite  similar  to  the  three  we  have  just 
described,  and  in  which  you  would  easily  recognize 
the  same  features. 

n 

Let  us  then  try  and  find  the  characteristic  feature  of 
the  observations  we  know.  You  have  noticed  your- 
selves, while  listening  to  me,  how  obvious  the  analogy 
is  between  the  phenomena  called  hysterical  fugues  and 
the  monoideic  somnambulisms  we  lately  studied.  In  a 
general  way,  the  essential  characters  are  the  same,  and 
we  could  without  difficulty  apply  to  the  former  the 


Fugues  and  Polyideic  Somnambulisms     55 

four  laws  we  applied  to  the  latter.  First,  during  the 
abnormal  state  there  is  a  certain  idea,  a  certain  system 
of  thoughts  that  develops  to  an  exaggerated  degree.  It 
is  evident  that  P.,  for  instance,  constantly  thinks,  during 
the  eight  days  his  fugue  lasts,  of  the  charge  brought 
against  him  by  his  brother,  of  the  consequences  it  may 
have  for  him,  and  of  the  means  of  eluding  capture.  It  is 
obvious  that  the  young  R.  ponders  during  three  months 
over  the  means  of  getting  to  the  Mediterranean  and 
the  hope  of  finding  a  ship  there  and  sailing  for  Africa. 
Such  thoughts  are  disproportionate  to  the  situation  of 
a  railway  officer,  the  father  of  a  family,  and  to  that  of  a 
grocer's  boy.  They  bring  about  certain  acts,  they  add 
to  the  endurance  of  those  people  who  travel  on  foot, 
work,  and  bear  hardships  without  difficulty. 

The  second  law  applies  equally  well.  During  the 
abnormal  state,  the  other  thoughts,  relating  to  the  for- 
mer life,  the  family,  the  social  position,  the  personality, 
appear  to  be  suppressed.  It  is  very  likely  that  during 
their  fugues  those  people  assume  false  names,  and 
create  for  themelves  fictitious  personalities;  you  will 
find  with  regard  to  this  last  detail  an  interesting  obser- 
vation in  the  paper  of  Mr.  H.  Coriat  of  Boston,  published 
in  the  third  number  of  The  Journal  of  Abnormal  Psy- 
chology, 1906,  p.  109.  The  important  point  is  that  these 
people  have  lost  the  memory  of  their  real  personality. 
This  seems  strongly  confirmed  by  the  phenomenon 
of  the  awakening.  When  some  chance  occurrence 
brings  back  to  their  mind  a  thought  about  their  family, 
their  real  name,  their  former  self,  they  fall  into  another 
system  of  ideas  and  wake  up.  This  proves  conclusively 


56        The  Major  Symptoms  of  Hysteria 

that,  during  the  abnormal  state,  chance  had  not  roused 
that  category  of  recollections. 

Outside  of  the  time  of  the  fit  or  of  the  abnormal 
state,  and  during  the  period  considered  as  normal 
(you  already  guess  it  is  not  entirely  so),  the  two  inverse 
laws  apply.  The  recollections  of  the  fugue  have  van- 
ished, and  that  to  an  extraordinary  extent.  But,  at 
the  same  time,  the  thoughts  and  feelings  connected 
with  an  idea  that  predominated  during  the  fugue  have 
disappeared  more  or  less  completely.  I  have  already 
pointed  out  to  you  that  young  R.  was  a  model  grocer's 
boy,  taking  much  interest  in  the  sugar  and  coffee  trade, 
dreaming  only  of  the  pleasure  of  going  on  Sundays 
with  his  mother  to  the  Saint- Cloud  fair,  and  having 
none  of  the  tastes  of  an  adventurous  sailor.  He  does 
not  continually  feel  this  longing  for  travels,  and  even 
grieves  very  much  when  you  speak  to  him  about 
-his  fugues.  He  is  afraid  they  may  begin  again,  since  he 
comes  of  himself  .to  the  hospital  in  order  to  get  advice 
and  be  rid  of  them.  I  insist  on  that  point.  If  the  boy 
really  had,  all  the  time,  a  taste  for  travels  beyond  the 
seas,  a  taste  which  after  all  he  might  have,  he  would 
not  feel  troubled  about  his  fugues;  he  would  resign 
himself,  in  the  idea  that,  if  they  were  successful,  they 
might  prove  profitable  to  him.  But  he  is  far  from 
doing  so,  for,  during  his  normal  life,  his  feelings  are  not 
the  same  as  during  the  period  of  his  fugue.  You  may 
observe  the  same  fact  in  the  railway  clerk,  P.  Wtyen 
he  is  awake,  he  does  not  speak  at  all  in  the  same  way 
of  the  charge  his  brother  brought  against  him ;  not  only 
does  he  realize  perfectly  that  there  is  no  truth  in  it, 


Fugues  and  Polyideic  Somnambulisms     57 

but  he  also  feels  that  it  is  of  no  importance.  He 
feels  it  is  not  worth  while  to  upset  his  home  and  spoil 
his  situation.  There  is  obviously  something  in  this  that 
recalls  the  amnesia  of  her  mother's  death  we  have 
noticed  in  Irene  and  the  disappearance  of  her  feelings 
of  filial  love. 

Lastly,  during  the  state  considered  as  normal  you  find 
the  development  of  the  psychological  phenomena  that 
were  suppressed  during  the  period  of  the  crisis:  rec- 
ollection of  the  entire  existence,  perception  of  all 
present  occurrences,  exact  notion  of  personality.  In 
short,  you  see  that  the  four  characteristic  laws  of  som- 
nambulisms apply  to  such  cases.  If  to  this  you  add 
that  these  fugues  present  themselves  in  individuals 
who  have  already  had,  as  I  told  you  in  the  case  of  P., 
fits  of  somnambulism;  or  if  you  remark  that  such 
individuals  are  apt  to  present  somnambulic  states  later 
on,  as  happened  with  Rou.,  it  seems  still  more  justi- 
fiable to  bring  the  two  phenomena  together  and  say 
that,  upon  the  whole,  fugues  are  kinds  of  hysteric  som- 
nambulisms. 

We  must  insist  a  little  while  upon  this  summary 
and  this  diagnosis.  In  my  opinion,  these  fugues  must 
be  ranked  among  hysterical  somnambulisms  for  two 
reasons :  first,  because  they  represent  to  us  all  the  major 
characteristics  already  known  of  hysterical  somnam- 
bulism. In  the  next  lecture  you  will  learn  a  new  char- 
acteristic of  this  somnambulism :  that  it  may  be  arti- 
ficially reproduced,  and  that  in  this  artificially  induced 
somnambulism  the  memory  of  the  first  abnormal  stage, 
of  the  fit  of  natural  somnambulism,  reappears  entirely. 


58        The  Major  Symptorlis  of  Hysteria 

This  new  characteristic,  which  we  shall  study  a  little 
later,  and  which  I  simply  allude  to,  can  be  still  found 
exactly  in  the  fugues  we  are  now  examining.  Long 
after  the  awakening  of  his  last  fugue,  when  he  seems 
to  have  no  remembrance  at  all  of  what  happened, 
the  young  Rou.  can  be  put  into  artificial  somnambu- 
lism and  can  then  relate  to  us  with  amusing  precise- 
ness  all  his  adventures  in  the  ship  laden  with  coal, 
and  his  friendship  with  the  donkey,  Cadet,  hauling 
the  rope  with  him.  When  all  these  characteristics,  and 
especially  the  last  one,  are  to  be  found  in  a  fugue,  it 
seems  to  me  difficult  to  class  this  phenomenon  apart 
from  hysterical  somnambulism  without  complicating  and 
confusing  all  the  psychological  classifications.  It  is 
only  when  the  phenomenon  which  seems  to  you  similar 
to  a  fugue  presents  other  characteristics  which  must  be 
studied,  that  you  can  frame  for  it  another  classification. 
The  second  reason  we  must  insist  upon  is  that  fugues 
of  this  kind,  exactly  characterized,  usually  appear  in 
the  life  of  some  subjects  who  have  had  already,  or  who 
will  have  later  on,  other  phenomena  connected  with  the 
accidents  we  know  as  hysterical  ones.  In  one  word, 
this  kind  of  fugues  appears  usually  in  hysterical  people. 
This  last  point  has  called  forth  a  number  of  interesting 
debates.  You  must  read  for  these  discussions  a  paper 
by  Dr.  J.  M.  Courtney,  of  Boston,  in  The  Journal  o] 
Abnormal  Psychology  in  August,  1906,  p.  123.  This 
author  quotes  a  number  of  fugues  which  seem  to  have 
appeared  in  subjects  who  were  formerly  affected  by 
epileptic  fits  —  in  a  word,  in  epileptic  subjects.  You 
must  discuss  with  great  care  the  observations,  you  must 


Fugues  and  Polyideic  Somnambulisms     59 

examine  whether  these  fugues  have  exactly  the  same 
character  as  the  preceding  ones.  It  is  necessary,  too,  to 
determine  exactly  the  diagnosis  of  the  fits  which  pre- 
ceded the  fugues,  the  diagnosis  of  epilepsy.  As  for 
me,  I  cannot  help  saying  that  I  often  doubt  these  diag- 
noses, that  I  am  not  sure  of  the  diagnosis  of  epilepsy 
in  all  the  cases  adduced  by  Dr.  Courtney  in  his  inter- 
esting paper.  But  in  the  end,  if  you  find  a  genuine 
case  of  fugue,  with  all  the  preceding  characteristics, 
in  a  subject  who  is  on  the  other  hand  an  epileptic, 
what  do  you  conclude  ?  The  neuroses  are  not  definite 
entities  which  exclude  one  another,  they  are  only  certain 
classifications  of  facts.  In  my  opinion,  you  must  only 
conclude  that  this  subject,  usually  severely  ill,  usually 
falling  into  serious  epileptic  fits,  has  once  had  a  less 
severe  attack,  which  is  connected  with  hysterical  rather 
than  with  epileptical  phenomena.  This  is  rather  fre- 
quent, and  is  not  inconsistent  with  the  important  com- 
parison we  made  just  now  of  the  phenomena  of  a  fugue 
and  those  of  hysterical  somnambulism. 

However,  we  must  not  delude  ourselves,  we  must 
recognize  differences.  First,  during  the  abnormal  state, 
the  idea  that  develops  has  certainly  not  the  same 
power  as  during  monoideic  somnambulism;  true,  it 
directs  the  conduct,  but  it  does  not  bring  on  the  halluci- 
nations and  deliriums  that  it  produced  in  the  preceding 
case.  When  Irene  had  the  idea  of  committing  suicide 
and  of  getting  herself  crushed  by  a  locomotive,  she  had 
not  patience  enough  to  go  to  the  railway  track  and  com- 
pass a  real  suicide;  she  immediately  had  the  hallucina- 
tion of  the  railway  track,  and,  without  more  ado,  lay 


60        The  Major  Symptoms  of  Hysteria 

down  on  the  floor  of  the  room.  Remember  that  differ- 
ence :  there  is  no  real  hallucination  in  the  fugue.  The 
development  of  the  idea  is  less  intense.  Secondly, 
the  idea  is  not  absolutely  isolated  as  in  somnambulism ; 
this  is  the  most  characteristic  fact.  Our  great  somnam- 
bulists, you  remember,  do  not  see  or  hear  anything 
but  what  concerns  the  idea  rooted  in  their  mind;  and 
it  could  not  be  otherwise,  for,  if  Irene  saw  the  beds 
in  the  room,  if  she  heard  my  voice,  she  would  not  be- 
lieve herself  alone  on  a  railway  track.  On  the  contrary, 
the  patients  who  make  fugues  need  a  great  many  per- 
ceptions and  recollections  to  enable  them  to  travel  with- 
out any  mishaps.  "  What  is  most  wonderful  in  fugues," 
Charcot  said,  "  is  that  these  individuals  contrive  not  to 
be  stopped  by  the  police  at  the  very  beginning  of  their 
journey."  In  fact,  they  are  mad  people  in  full  delirium; 
nevertheless,  they  take  railway  tickets,  they  dine  and 
sleep  in  hotels,  they  speak  to  a  great  number  of  people. 
We  are,  it  is  true,  sometimes  told  that  they  were  thought 
a  little  odd,  that  they  looked  preoccupied  and  dreamy, 
but  after  all,  they  are  not  recognized  as  mad  people; 
whereas  Irene  could  not  take  two  steps  in  the  street, 
when  she  was  dreaming  of  her  mother's  death,  without 
being  immediately  taken  to  the  asylum.  So  you  see 
that  the  range  of  consciousness  is  not  at  all  the  same, 
that  the  mind  is  not  distinctly  reduced  to  a  single  idea. 
We  can  make  the  same  remark  concerning  the  state 
called  normal:  the  oblivion  of  the  fugue  is  total, 
but  the  oblivion  of  the  directive  idea  and  of  the  feel- 
ing connected  with  it  is  by  far  less  distinct,  and  the 
restoration  of  the  normal  self  is  much  more  complete. 


Fugues  and  Polyideic  Somnambulisms     61 

In  short,  the  difference  could,  I  believe,  be  explained 
in  the  following  remark:  A  fugue  lasts  much  longer 
than  a  monoideic  somnambulism.  While  the  latter 
lasts  a  few  hours  at  most,  the  former  lasts  for  months 
together.  It  is  necessary  for  a  fugue  to  be  able  to  last 
so  long  that  the  state  should  approach  the  normal 
state,  and  that  the  character  of  somnambulism  should 
be  attenuated. 

Ill 

In  order  to  understand  that  degradation,  that  trans- 
formation of  monoideic  somnambulism  into  the  hysteri- 
cal fugue,  we  must  study  states  of  mind  which  are  in 
some  manner  intermediate,  and  they  will  prepare  us  to 
understand  the  transformations  of  typical  somnam- 
bulism. I  mean  polyideic  somnambulisms,  which  are 
opposed  to  the  first,  as  their  name  shows,  by  the  multi- 
plicity of  the  ideas  that  fill  them. 

One  instance  will  be  enough  to  make  you  under- 
stand how  somnambulism  can  pass  from  one  idea  to 
several.  Here  is  an  hysterical  woman,  Leg.,  who  has  led 
a  very  eventful  life,  and  has  had  several  very  dramatic 
adventures,  capable  of  upsetting  her  mind  and  filling 
her  head  with  those  fixed  ideas  that  lead  to  somnambu- 
lisms. One  day,  at  the  period  of  her  menstrual  dis- 
charge, she  had  searched  her  lover's  desk  and  had  found 
a  letter  that  confirmed  her  suspicions,  showing  her  that 
he  had  deceived  her.  She  fell  into  a  great  passion ;  her 
menstrual  discharge  was  stopped,  of  course,  and  she  had 
a  crisis  of  delirium  in  the  form  of  monoideic  somnam- 
bulism, during  which  she  acted  the  scene  over  again. 


62        The  Major  Symptoms  of  Hysteria 

Another  day,  as  she  was  taking  a  walk  with  her  lover, 
she  had  been  surprised  by  a  violent  storm  and  fright- 
ened by  a  very  loud  thunderclap.  Her  lover,  it  appears, 
had  not  proved  courageous,  and  had  not  been  equal  to 
the  task  either  of  reassuring  her  or  of  finding  a  shelter 
for  her.  She  got  terribly  angry  with  him,  had  a  violent 
crisis  of  somnambulism,  during  which  she  heard  the 
thunderclap,  fainted,  and  then  made  a  scene  with  her 
lover.  That,  again,  is  quite  simple  and  conformable 
to  the  rule.  Now  a  third  story.  One  day,  again  at  the 
period  of  her  menstrual  discharge,  she  stole  a  revolver, 
placed  herself  in  ambuscade  on  the  roadside,  and  saw  a 
carriage  pass  by  in  which  was  her  lover  with  her  rival. 
She  shot  at  them,  and  fell  back  in  a  crisis  of  delirium. 
Other  adventures  happened  to  her,  the  result  of  which 
was  the  same. 

After  all  these  accidents,  she  was  admitted  into  the 
hospital,  and  nearly  every  day,  on  the  slightest  occasion, 
she  falls  into  crises  of  delirium.  These  crises  begin  at 
hazard,  by  the  recital  or  by  the  acting,  as  you  please, 
of  one  of  her  adventures.  She  has  a  haggard  look, 
trembles,  and  puts  her  hands  before  her  face  with  an 
expression  of  violent  terror.  She  shuts  her  eyes  as  if 
before  flashes  of  lightning,  and  acts  the  scene  of  the 
storm;  then,  suddenly,  without  awakening,  her  face 
takes  on  another  expression.  She  seems  to  be  looking 
for  keys,  breaks  open  drawers,  reads  letters,  utters 
shrieks  of  fury.  Lastly,  her  hands  grasp  an  imaginary 
revolver,  she  looks  out  at  the  window  with  an  infuriated 
air,  pulls  the  trigger,  and  falls  back  in  a  fainting  fit. 
These  three  scenes  and  others  quite  like  them  begin 


Fugues  and  Polyideic  Somnambulisms     63 

over  and  over  again  indefinitely,  succeeding  one  another, 
but  not  always  in  the  same  order.  They  may  last  for 
hours  together.  That  is  again  a  somnambulic  state. 
The  mind  is  likewise  concentrated  on  one  idea,  and 
remains  closed  to  external  things.  But  the  ideas  are 
manifold  and  bring  on  different  comedies,  during  which 
the  perceptions  and  memories  are  not  the  same.  The 
unity  of  the  somnambulism  is  broken;  there  is  some- 
thing foreign  to  the  idea  itself  that  has  unified  those  three 
or  four  ideas  and  has  gathered  them  into  one  crisis. 

The  same  character  may  be  observed,  though  with 
somewhat  greater  complication,  in  another  form  of 
polyideic  somnambulism.  I  take  as  a  starting-point 
the  rather  simple  observation  of  a  young  girl  twenty 
years  old,  Ra.  This  young  girl,  as  it  appears,  found  a 
situation  at  a  tavern  keeper's ;  the  man  was  very  brutal, 
and  beat  and  abused  her  in  every  way.  She  got  to  look 
upon  him  with  abhorrence,  and  fell  into  crises  of  de- 
lirium during  which  she  acted  over  again  the  scenes 
she  had  lived  through  in  the  tavern.  The  principal 
one  was  a  scene  of  rape;  she  shrieked  and  resisted  the 
brutal  fellow.  That  is  a  monoideic  somnambulism. 
But,  as  she  runs  about  the  room,  she  finds  a  broom. 
Immediately  she  takes  it,  and,  keeping  on  her  face  the 
same  look  of  terror,  she  begins  to  sweep  the  room  with- 
out seeming  to  think  in  the  least  of  the  scene  of  the  rape. 
Another  time,  it  appears,  she  found  a  wheelbarrow  and 
rolled  it  about  the  yard  for  hours.  It  is  clear  that  the 
act  of  rolling  the  wheelbarrow  is  not  connected  with 
the  thought  of  the  rape.  This  is,  as  you  see,  a  second 
form  of  polyideic  somnambulism,  in  which  the  ideas 


64        The  Major  Symptoms  of  Hysteria 

are  not  modified  by  the  memory  of  previous  somnam- 
bulisms, but  by  the  impression  determined  by  outward 
objects  which  the  subject  still  perceives. 

I  could  show  you,  as  a  third  form,  somnambulisms 
in  which  the  change  of  ideas  seems  to  take  place  more 
easily  still:  simply  through  an  association  of  ideas. 
Read  again  the  amusing  observation  about  the  som- 
nambulist of  Mesnet  already  described  in  1874.  That 
man  had  a  very  varied  somnambulism,  during  which, 
in  turn,  he  acted  scenes  of  military  life,  then  played 
music  or  fancied  himself  a  servant,  according  to  the 
impressions  he  received.  One  idea,  awakened  by  an 
association,  develops  into  a  comedy;  it  awakens  an- 
other, then  a  third,  and  so  on  indefinitely.  Somnam- 
bulisms are  thus  very  complicated  sometimes,  and 
apparently  filled  with  a  great  many  different  ideas. 

But  we  must  then  ask  ourselves  what  makes  the  unity 
of  these  somnambulisms.  Can  we  still  apply  here  the 
general  conception  which  was  simple  in  the  cases  of 
monoideic  somnambulism?  We  summed  up  those 
states  in  a  few  words.  There  is  a  simple  idea,  a  system 
of  images  which  has  separated  from  the  totality  of 
consciousness  and  has  an  independent  development. 
It  brings  about  two  things:  a  blank  in  the  general 
consciousness,  which  is  represented  by  an  amnesia, 
and  an  exaggerated  and  independent  development  of 
the  emancipated  idea.  Now  we  find  nothing  of  the 
kind  here ;  we  do  not  find  one  distinct  idea,  one  precise 
system  that  has  emancipated  itself  from  consciousness; 
a  great  many  different  ideas  seem  to  characterize  the 
somnambulism. 


Fugues  and  Polyideic  Somnambulisms     65 

I  think  for  my  part  that  the  difficulty  lies  on  the  sur- 
face, and  that  at  bottom  the  phenomena  remain  the 
same.  The  psychological  systems  that  exist  in  our 
consciousness  are  very  numerous,  and  they  do  not  all 
present  themselves  in  the  same  form.  No  doubt 
one  of  the  simplest  systems  is  the  idea  relative  to  an 
event.  The  idea  of  one's  mother's  death  is  a  well-defined 
system  which  can  be  suppressed  clearly  or  can  develop 
separately.  But  there  are  other  vaguer  systems,  a 
great  number  of  which  we  shall  have  to  study.  I  only 
point  out  to  you  for  the  present  the  system  of  thoughts 
and  of  tendencies  that  is  called  a  feeling,  or  an  emotion. 
It  is  not  so  clear  as  an  idea,  but  nevertheless  it  exists 
with  some  unity.  The  feeling  that  arises  from  the  fear 
of  an  ignominious  charge,  the  feeling  of  curiosity  for 
distant  countries,  the  feeling  of  love  and  jealousy  tow- 
ards a  lover,  the  feeling  of  bondage  to  a  hated  master, 
—  these  are  systems  of  thoughts  that  it  is  not  always  easy 
to  express  in  words,  that  are  not  ideas,  properly  so  called, 
that  may  on  the  contrary  enclose  very  many  different 
ideas,  but  that  nevertheless  possess  a  mental  unity. 

Well,  in  polyideic  somnambulisms  and  in  fugues,  it  is 
upon  this  more  serious  feeling  that  the  dissociation  has 
borne.  It  is  a  feeling  in  its  entirety,  a  more  or  less 
precise  feeling  that  has  separated  from  general  con- 
sciousness, and  that  develops  in  an  independent  way, 
giving  birth  to  these  odd  deliriums.  A  certain  com- 
plexity differentiates  these  phenomena  from  somnam- 
bulism, but  we  apply  to  them  the  same  general  law 
and  the  same  interpretation. 


LECTURE   IV 
DOUBLE   PERSONALITIES 

The  interest  of  the  study  0}  these  rare  cases  —  First  type  of 
double  existence,  the  "Lady  oj  MacNish" —  The  recip- 
rocal somnambulisms  —  A  graphic  method  for  the  represen- 
tation of  amnesias  —  Second  type  of  double  existence,  Fe- 
lida  X.  —  The  dominating  somnambulisms  —  The  group 
of  complex  cases  —  A  case  of  artificial  double  existence  — 
The  true  denomination  of  the  different  states  —  The  oscil- 
lations of  mental  level  and  the  dissociation  of  a  state  of 
mental  activity 

THE  somnambulisms  which  we  consider  as  the  es- 
sential phenomenon  of  hysteria  are  apt  to  present  a  new 
metamorphosis,  whose  scientific  interest  is  very  great, 
when  they  are  so  protracted  and  complicated  as  to  give 
rise  to  what  is  called  double  existences,  double  personali- 
ties. I  said  scientific  interest,  rather  than  clinical  and 
practical  interest,  because  this  phenomenon  is,  upon 
the  whole,  rather  rare,  and  it  is  unlikely  you  will  have 
to  occupy  yourselves  with  it  in  practice.  A  celebrated 
neurologist  of  New  York  —  M.  Dana  —  published  in 
1894  in  the  Psychological  Review,  p.  570,  a  compre- 
hensive study  on  the  most  definite  cases  which  have  been 
observed,  and  he  counted  only  sixteen.  In  the  last 

66 


Double  Personalities  67 

number  of  his  Journal  of  Abnormal  Psychology,  p.  186, 
Dr.  Morton  Prince  gave  a  fine  table  of  twenty  cases,  of 
which  he  explained  the  most  interesting  features.  Let 
us  suppose  there  are  to-day  twenty-five  or  thirty,  —  it  is 
certainly  the  total  sum  of  the  well-known  cases.  Such 
cases  are  not  often  met  with  in  usual  practice ;  however, 
the  importance  of  this  fact  is  very  great.  Its  very 
exaggeration  allows  us  better  to  interpret  the  preceding 
states,  and  contributes  very  efficaciously  to  instruct 
us  on  the  theory  of  hysteria.  Moreover,  the  question 
presents  for  you,  as  it  were,  a  national  interest.  For 
some  reason  —  why,  I  don't  know  —  it  is  in  America 
that  the  greatest  number  of  remarkable  cases  have 
appeared,  and  it  is  American  doctors,  among  them 
MacNish,  Wood,  Weir  Mitchell,  Dana,  and  quite  re- 
cently one  of  the  greatest  physicians  of  this  town, 
Dr.  Morton  Prince,  who  have  devoted  to  it  the  most 
remarkable  studies. 

We  cannot,  in  an  elementary  lesson,  discuss  the  differ- 
ent forms  of  this  phenomenon  and  the  various  theories 
which  have  been  presented.  I  refer  you  for  this  sub- 
ject to  the  recent  book  of  Dr.  Morton  Prince,  "Dis- 
sociation of  a  Personality,"  1906,  and  to  that  of  MM. 
B.  Sidis  and  Goodhart,  "Multiple  Personality,"  1905. 
You  will  find  in  these  works  all  kinds  of  psychological 
discussions  in  which  I  should  not  like  to  venture.  So 
I  shall  confine  myself  to  making  three  typical  forms 
known  to  you  and  to  showing  you  in  a  few  words  in 
what  manner  these  new  states,  which  present  so  many 
interesting  features,  are  connected  with  the  preceding 
somnambulisms. 


68        The  Major  Symptoms  of  Hysteria 


The  type  of  double  existences  is  given  us  by  a  cele- 
brated case,  more  legendary  than  historical,  published 
in  1831,  in  a  work  of  Dr.  MacNish,  entitled  "Philosophy 
of  Sleep";  whose  observation,  it  appears,  dates  still 
farther  back,  since  it  is  a  question  of  a  fact  observed  by 
Mitchell  and  Elliot  in  I8I6.1  It  shows  you  that  this 
observation  is  very  old  and  very  vaguely  known. 
This  is  perhaps  the  reason  why  the  fact  is  presented  to 
us  with  a  simplicity  which  astonishes  us,  and  which  we 
no  longer  find  in  our  observations  of  to-day.  By 
much  repetition  the  fact  must  have  become  a  great  deal 
simplified;  however  it  may  be,  the  following  is  the 
abridged  history  of  her  who  is  called  the  "Lady  of 
MacNish." 

A  well-informed,  well-bred  young  lady  of  a  good  con- 
stitution was  suddenly  seized,  without  previous  warn- 
ing, with  a  profound  sleep,  which  lasted  several  hours 
longer  than  usual.  On  awaking,  she  had  forgotten 
all  she  knew ;  her  memory  was  like  a  tabula  rasa,  and 
had  preserved  no  notion  either  of  words  or  of  things; 
it  was  necessary  to  teach  her  everything  anew.  Thus 
she  was  obliged  to  learn  again  reading,  writing,  cipher- 
ing. Little  by  little  she  became  familiarized  with  the 
persons  and  things  surrounding  her,  which  were  for 
her  as  if  she  saw  them  for  the  first  time.  Her  progress 
was  rapid.  After  a  rather  long  time  she  was,  without 
any  known  cause,  seized  with  a  sleep  similar  to  that 

1  "The  Medical  Repository,"  1816. 


Double  Personalities  69 

which  had  preceded  her  new  life.  On  awaking,  she 
found  herself  exactly  in  the  same  state  in  which  she 
was  before  her  first  sleep.  But  she  had  no  remembrance 
of  anything  that  had  passed  during  the  interval.  In  a 
word,  in  the  old  state  she  was  ignorant  of  the  new  state. 
It  was  thus  that  she  called  her  two  lives,  which  were 
continued  separately  and  alternatively  through  remem- 
brance. During  more  than  four  years  this  young 
lady  presented  these  phenomena  almost  periodically. 
In  one  state  or  in  the  other,  she  did  not  remember  her 
double  character,  any  more  than  two  distinct  persons 
remember  their  respective  natures;  for  instance,  in 
the  periods  of  her  old  state,  she  possessed  all  the  knowl- 
edge she  acquired  in  her  childhood  and  youth;  in  her 
new  state,  she  knew  only  what  she  had  learned  during  her 
first  sleep.  If  a  person  was  presented  to  her  in  one  of 
these  states,  she  did  not  know  this  person  in  the  other 
state,  but  was  obliged  to  study  and  know  him  in  both 
to  have  a  thorough  notion  of  him.  And  it  was  the 
same  with  everything.  In  her  old  state  she  had  a  very 
fine  handwriting,  the  one  she  had  always  had,  while  in 
her  new  state  her  handwriting  was  bad,  awkward,  as  it 
were,  childish,  because  she  had  neither  the  time  nor 
the  means  to  perfect  it.  As  has  been  said  above,  this 
succession  of  phenomena  lasted  four  years,  and  Mrs.  X. 
was  accustomed  to  it,  and  had  succeeded  easily  in 
maintaining  an  intercourse  with  her  family.1 

In  connection  with  this  case,  I  should  like  to  avail 

'In  connection  with  this  case,  see  Azam,  "Les  alterations  de  la 
personality,  in  Revue  scientifique,  1883,  II,  p.  616,  and  id.,  "Hypno- 
tisme  et  double  conscience,"  1893,  p.  136. 


yo        The  Major  Symptoms  of  Hysteria 

myself  of  the  opportunity  to  lay  before  you  a  graphic 
method  which  I  once  invented  and  of  which  I  make 
great  use  in  my  lectures  before  the  French  students. 
This  schema,  I  believe,  enables  us  to  represent  to  our- 
selves the  various  disturbances  of  memory  in  a  very 
simple  manner  and  makes  their  different  varieties 
clearly  perceptible  to  the  eye.  No  doubt  you  are  al- 
ready accustomed,  in  your  courses  of  medicine,  to  the 
little  schemata  which  are  made  use  of  to  represent  the 
various  lesions  of  the  organs,  and  especially  to  repre- 
sent the  disturbances  of  sensibility.  There  existed  no 
schemata  of  this  kind  for  the  disturbances  of  memory, 
for  we  have  to  deal  with  a  considerable  difficulty  of  rep- 
resentation. There  are,  indeed,  in  a  remembrance  or 
in  an  oblivion  two  different  things  which  must  be  rep- 
resented simultaneously.  We  must  first  consider  the 
time  when  the  remembrance  exists:  for  instance,  it  is 
to-day  that  I  remember  the  studies  on  double  conscious- 
ness ;  this  is  the  date  of  the  appearance  of  the  remem- 
brance. We  must  also  consider  in  a  remembrance  the 
past  period  to  which  it  refers;  I  remember,  to-day  in 
1906,  that  I  already  came  in  Boston  in  1904;  it  is 
the  period  to  which  the  remembrance  refers.  To 
represent  these  two  things  simultaneously,  I  propose 
to  you  the  following  schema,  which  is  described  in  my 
book  on  Nevroses  et  I  dees  fixes,  1898,  Vol.  I,  p.  124. 

The  horizontal  line  OX  in  all  these  Figures  2,  3,  4,  5, 
from  the  left  to  the  right,  designates  the  different 
periods  of  the  course  of  life  in  their  order  of  appearance. 
It  is  on  this  line  that  we  inscribe  the  remembrances  at 
the  moment  of  their  appearance.  The  vertical  line  OF, 


Double  Personalities  71 

from  the  bottom  to  the  top,  represents  the  same  periods, 
but  as  remembrance,  as  representation.  At  each  point 
of  the  horizontal  line  we  draw  a  perpendicular  parallel 
to  the  vertical  line  which  represents  the  remembrances ; 
its  height  represents  the  number  of  remembrances  one 


"December 


FIG.  2.  —  Schema  of  a  case  of  retrograde  amnesia:  case  of  Kaempfen, 


possesses  at  such  or  such  a  moment.  As  this  height 
naturally  increases  as  life  passes  away,  and  one  can 
theoretically  call  up  more  remembrances,  normal 
memory  will  be  represented  by  this  triangle,  whose 
base  is  the  horizontal  line  OX,  and  which  is  formed  by 


72        The   Major  Symptoms  of  Hysteria 

the  diagonal  drawn  from  the  point  O.  If  you  have  to 
represent  oblivions,  amnesias,  you  will  mark  a  black 
spot  above  the  point  representing  the  date  at  which  this 
accident  took  place,  and  the  height  of  this  black  spot 
will  be  determined  by  the  parallel  line  which  meets  on 
the  vertical  the  forgotten  remembrance.  This  figure, 
not  very  complicated,  upon  the  whole,  allows  us  to  rep- 
resent the  different  amnesias  in  a  very  clear  and  striking 
manner. 

As  examples,  and  in  order  to  accustom  your  eyes  to 
these  schemata,  which  are  very  useful  in  clinical  studies, 
I  put  before  you  various  figures  representing  the  more 
usual  forms  of  amnesias  which  you  will  meet  with  in 
your  practice.  You  have  already  studied  with  your 
masters  of  neurology  and  psychiatry  the  retrograde 
amnesia  (Figure  2)  which,  beginning  after  some  physical 
or  moral  shock,  takes  away  all  the  memories  of  the  pre- 
ceding time;  you  know,  too,  the  continuous  amnesia 
(Figure  3),  wiping  out  the  remembrances  of  events 
as  life  goes  on,  continuously.1  You  see  that  the  general 
aspect  of  the  schema  is  quite  different,  and  that  it  puts 
into  evidence  the  differences  between  the  two  diseases  of 
the  memory. 

We  can  now  apply  this  method  of  representation  to 
the  double  existences  we  were  studying.  In  Figure  4  I 
have  drawn  a  figure  representing  the  case  of  the  "Lady 
of  MacNish,"  and  you  see  that  it  is  very  characteristic. 
It  is  a  kind  of  draught-board,  in  which  black  and  white 
squares  alternate  very  exactly.  You  will  remark,  in 

1  See  "L'amnesie  continue,"  in  Nevroses  et  I  dees  fixes,  1898,  I, 
p.  109. 


Double  Personalities 


73 


fact,  that  in  this  singular  history  the  oblivions  and 
remembrances  alternate  in  the  same  way  very  regularly. 
In  the  state  called  state  No.  i,  the  "Lady  of  Mac- 
Nish"  does  not  remember  the  state  No.  2  at  all;  in 
the  state  No.  2  she  does  not  remember  the  state  No.  i 


1891    Ma; 


MJ JA80NDJ PMAMJJ A  BOND JF MAM J JASON DJ FMAUJ  JA80NDJ 
1891  1892  ,.1893  180*  1896 


FIG.  3.  — This  scheme  represents  all  the  modifications  of  the  memory  during 
four  years  of  a  patient,  Mrs.  D.,  presenting  continuous  amnesia  after  a 
shock  of  emotion. 

at  all.  When  she  comes  back  to  the  state  No.  i,  she 
remembers  only  this  state  and  nothing  more.  It  is  the 
same  when  she  comes  back  to  the  state  No.  2.  There 
is  in  the  disease  a  perfect  alternation  which  the  schema 
illustrates  very  well  by  its  draught-board,  and  which 
is  quite  peculiar  to  this  type  of  patients.  I  have  pro- 


74        The  Major  Symptoms  of  Hysteria 

posed  to  call  this  form  of  somnambulisms,  "  reciprocal 
somnambulisms."  l 

Double  existences  of  such  a  simple  form  are  very 
rare.  It  very  seldom  occurs  that  the  subject  in  his 
abnormal  existence  has  entirely  forgotten  his  normal 
existence,  and  that  in  the  latter  he  has  likewise  entirely 
forgotten  the  other  period.  This  absolute  division  of 
life  into  two  alternating  periods  which  do  not  know 
each  other  at  all  is  quite  exceptional:  we  can  connect 
only  a  small  number  of  cases  with  the  type  of  the  "  Lady 
of  MacNish."  The  case  of  Dana  is  perhaps  of  this 
kind,  but  at  all  events  the  disease  lasted  a  much  shorter 
time.  Two  cases  of  Charcot,  that  of  Marguerite  D. 
and  that  of  Habillon,  which  you  will  find  published  in 
the  last  two  volumes  of  his  works,  and  which  have  been 
reported  by  M.  Guinon,  approach  this  form.  But 
certainly  the  finest  modern  case  analogous  to  that  of 
MacNish  appears  to  me  to  be  the  history  of  Mary 
Reynolds,  published  by  Dr.  Weir  Mitchell  in  i888.2 

Mary  Reynolds  was  an  intelligent,  calm  child,  rather 
reserved  and  melancholy,  but  of  apparent  good  health. 
The  nervous  disturbances  began  towards  the  age  of 
eighteen  with  a  rather  protracted  syncope,  after  which 
she  remained  for  five  or  six  weeks  blind  and  deaf.  The 
sense  of  hearing  returned  all  at  once,  the  sense  of  sight 

1  The  reciprocal   somnambulisms  in  "  L'etat  mental  des  Hyste"- 
riques,"  1894,  II,  p.  197;  "The  Mental  State  of  Hystericals,"  trans- 
lation by  Mrs.  C.  R.  Corson,  New  York,  G.  P.  Purnam's  Sons,  1901, 
p.  419. 

2  S.  Weir  Mitchell,  "  Mary  Reynolds,  a   Case   of  Double   Con- 
sciousness," in  The  Transactions  of  the  College  of  Physicians  of  Phila- 
delphia, April  4,  1888. 


Double  Personalities 


75 


State  I 


U 


II 


II 


FIG.  4.  —  Schema  of  the  reciprocal  somnambulisms  in  the  case  of  the 
"  Lady  of  MacNish." 

returned  gradually  and  completely.  We  need  not  dwell 
now  on  these  sensorial  disturbances,  which  we  shall 
study  later  on.  After  p,  second  syncope,  which  lasted 
from  eighteen  to  twenty  hours,  she  awoke,  apparently 
with  all  her  senses,  but  she  had  forgotten  all  her  former 
life  and  all  the  knowledge  previously  acquired ;  nothing 
was  left  her  but  the  power  of  instinctively  pronouncing, 
like  a  child,  a  few  words,  without  understanding  them. 
She  was  obliged  to  learn  everything  anew.  But  it 


76        The  Major  Symptoms  of  Hysteria 

must  be  acknowledged  that  her  education  was  rapid, 
since,  after  a  few  weeks,  she  could  again  speak,  read,  and 
write.  It  was  noticed  that  she  learned  again  to  write 
in  an  odd  manner:  she  handled  her  pen  awkwardly, 
and  began  to  copy  from  the  right  to  the  left,  after  the 
manner  of  the  Orientals.  She  always  kept,  in  this 
second  existence,  an  inverted  handwriting  very  different 
from  her  ordinary  handwriting  In  this  second  existence 
her  character  was  quite  transformed :  she  had  become 
lively,  cheerful,  was  no  longer  afraid  of  anything, 
wandered  about  the  woods,  played  with  dangerous 
animals;  she  dealt  shrewdly  with  and  mocked  at  the 
persons  who  wanted  to  direct  her,  and,  in  reality,  no 
longer  obeyed  anybody.  After  about  ten  weeks  she 
again  had  one  of  those  strange  sleeps,  and  awoke  of 
herself  in  the  first  state.  She  no  longer  had  any  re- 
membrance of  the  period  which  had  just  elapsed,  but 
she  recovered  her  previous  knowledge  and  character. 
She  was  slower  and  more  melancholy  than  ever. 

After  some  time,  the  same  -accident  caused  her  to 
return  to  the  state  which  appeared  to  be  the  second. 
These  transitions  often  took  place  in  the  night  during 
her  natural  sleep,  sometimes  in  the  daytime,  and  they 
were  often  painful.  The  subject  was,  as  it  were, 
frightened  by  a  kind  of  feeling  of  death,  "as  if  I  were 
never  to  return  into  this  world."  When  the  second 
existence  reappeared,  Mary  Reynolds  was  again  exactly 
in  the  state  in  which  she  had  been  at  the  end  of  the 
corresponding  period,  with  the  same  acquired  knowl- 
edge and  the  same  remembrances;  but  she  again 
forgot  everything  when  she  returned  to  the  state  No.  i. 


Double  Personalities  77 

About  the  age  of  thirty-five  or  thirty-six,  the  state 
called  No.  2  became  definitively  predominant.  It  was 
reproduced  more  often,  lasted  longer,  and  at  length 
became  in  a  manner  definitive,  since  she  remained 
twenty-five  years  in  this  state.  The  author  remarks 
that,  at  the  end  of  her  life,  there  seemed  to  be  a  kind 
of  confusion  between  the  two  states;  at  least  the  state 
No.  2,  which  had  become  preponderant,  expanded,  and 
seemed  vaguely  to  acquire  remembrances  belonging  to 
the  state  No.  i.  "It  seemed  to  her  that  she  had,  as 
it  were,  an  obscure,  dream-like  idea  of  a  shadowy  past 
which  she  could  not  quite  grasp." 

You  see  that,  in  general,  the  observation  of  Mary 
Reynolds  is  the  one  which  most  approaches  that  of 
the  "Lady  of  MacNish, "  and  which  best  presents  the 
two  existences  quite  independent  of  each  other.  How- 
ever, even  in  this  case,  you  remark,  at  the  end  of  life, 
a  tendency  of  the  state  No.  2  to  encroach  upon  state 
No.  i.  This  will  be  found  to  be  the  essential  char- 
acteristic of  another  form  of  double  existence  much 
more  common  than  the  first. 

II 

I  have  given  to  this  new  form  the  name  of  domi- 
nating somnambulism,  because  one  of  its  essential 
features  is  that  one  of  the  states  dominates  the  other. 
In  this  state,  the  subject  is  more  active,  more  lively, 
more  intelligent  than  in  the  other,  and  what  is  particu- 
larly important,  the  memory,  during  this  state,  is  much 
more  extended  than  in  the  other. 


78        The  Major  Symptoms  of  Hysteria 

If  America  can  boast  of  having  presented  in  the 
person  of  the  "Lady  of  MacNish"  and  in  that  of 
Mary  Reynolds  the  finest  examples  of  the  first  form,  the 
history  of  Felida  X.  gives  now  to  France  an  unques- 
tionable superiority.  Allow  me  to  make  you  acquainted 
with  Felida.  She  is  a  very  remarkable  personage  who 
has  played  a  rather  important  part  in  the  history  of 
ideas.  Do  not  forget  that  this  humble  person  was  the 
educator  of  Taine  and  Ribot.  Her  history  was  the 
great  argument  of  which  the  positivist  psychologists 
made  use  at  the  time  of  the  heroic  struggles  against 
the  spiritualistic  dogmatism  of  Cousin's  school.  But 
for  Felida,  it  is  not  certain  that  there  would  be  a  profess- 
orship of  psychology  at  the  College  de  France,  and 
that  I  should  be  here,  speaking  to  you  of  the  mental 
state  of  hystericals.  It  is  a  physician  of  Bordeaux  who 
has  attached  his  name  to  the  history  of  Felida :  Azam 
reported  this  astonishing  history  first  at  the  "  Society 
of  Surgery,"  then  at  the  "  Academy  of  Medicine,"  in 
January,  1860.  He  entitled  his  communication,  "  Note 
on  Nervous  Sleep  or  Hypnotism,"  and  spoke  of  this  case 
in  connection  with  the  discussion  of  the  existence  of  an 
abnormal  sleep  during  which  it  would  be  possible  to 
operate  without  pain.  And  this  communication,  thus 
incidentally  made,  was  to  revolutionize  psychology  in 
fifty  years.  Subsequent  to  that  time,  Azam  under- 
stood better  the  interest  and  success  of  his  observation ; 
he  published  various  memoirs,  and  even  books  on  this 
subject,  in  1866,  1876,  1877,  1883,  1890.  As  I  told 
you,  first  Taine,  in  his  book  on  "  Intelligence,"  then 
Ribot,  in  his  "  Diseases  of  Memory,"  took  possession 


Double  Personalities  79 

of  this  history,  which  has  gone  round  the  world,  and 
to-day  there  is  a  whole  library  written  about  this  poor 
woman. 

When  Azam  first  knew  Felida  in  1858,  she  was  already 
fifteen  years  old,  and  had  already  been  ill  for  three  years 
since  the  appearance  of  puberty.  This  frequently 
occurs  in  hysteria,  as  you  will  see  later  on.  She  had 
all  kinds  of  hysteric  accidents,  attacks  of  motor  agita- 
tion, disturbances  of  alimentation,  which  we  need  not 
examine  now.  All  kinds  of  sufferings  had  changed 
her  character  for  the  worse ;  she  was  a  reserved,  melan- 
choly, and  timid  person.  She  had  a  great  number  of 
disturbances  of  sensibility,  consisting  both  of  pains 
and  diffuse  insensibilities. 

Among  all  these  miseries,  there  appeared  from  time 
to  time,  rather  infrequently  at  the  beginning,  another 
very  strange  phenomenon.  She  seemed  to  faint  away 
for  a  very  few  minutes;  it  is  the  transition  we  have 
already  remarked  in  most  somnambulisms.  Then 
she  would  wake  up  suddenly,  become  gay  and  active, 
and  bustle  about,  without  any  anxiety  or  pain ;  she  no 
longer  had  those  painful  sensations  or  those  insensi- 
bilities which  troubled  her  before,  and  she  was  in  much 
better  health  than  in  the  preceding  period.  But  let  us 
immediately  remark  that  in  this  apparently  new  state 
she  by  no  means  presented  the  characteristic  disturbance 
of  the  "Lady  of  MacNish"  and  of  Mary  Reynolds. 
She  had  nothing  to  learn  again,  because  she  had  for- 
gotten nothing:  she  preserved  a  very  clear  remem- 
brance of  all  her  former  life,  of  all  the  sufferings  she 
had  undergone,  and  of  all  she  had  learned  before. 


8o        The  Major  Symptoms  of  Hysteria 

So  everything  went  quite  well ;  but  this  state  of  comfort 
lasted  but  a  short  time.  After  one  to  three  hours,  she 
had  a  new  syncope,  and  then  awoke  in  the  preceding 
state,  considered  as  normal,  which  we  may  call,  accord- 
ing to  Azam's  convention,  the  prime  state.  On  return- 
ing to  this  state,  she  resumed  again  all  her  infirmities, 
and  the  slow,  melancholy  character  which  was  her 
usual  one.  But  there  was  now  one  phenomenon  more : 
she  had  quite  forgotten  the  few  preceding  hours  filled 
by  the  state  No.  2,  or  the  lively  state.  All  this  period 
was  for  her  as  if  it  did  not  exist. 

This  caused  no  great  inconvenience  at  that  time,  since 
the  state  called  No.  2  occurred  only  from  time  to  time 
and  lasted  an  hour  or  two.  But,  little  by  little,  this 
state  developed  singularly ;  it  lasted  for  hours  and  days, 
and  as  the  subject  was  now  much  more  active,  it  was 
filled  with  all  kinds  of  serious  incidents.  You  will 
read  in  Azam  the  strange  narrative  of  that  consultation 
about  the  first  pregnancy  of  Felida.  The  poor  girl, 
during  her  period  of  excitation  and  gayety,  had  given 
herself  up  to  a  young  man  who  was  to  be  her  husband. 
The  awakening  occurred  shortly  afterwards,  and  did 
not  leave  her  the  least  remembrance  of  this  incident. 
As  her  health  was  impaired,  and  her  abdomen  grew 
bigger,  she  naively  went  to  consult  M.  Azam  about  the 
strange  disturbances  in  her  health.  "The  pregnancy 
was  evident,"  says  Azam,  "but  I  dared  not  make  it 
known  to  her."  Some  time  after,  the  state  No.  2 
returned,  and  Felida,  addressing  herself  to  the  physi- 
cian, laughingly  apologized  for  her  preceding  consulta- 
tion, for  she  now  knew  very  well  what  was  the  matter. 


Double  Personalities  81 

During  the  greater  part  of  her  life,  these  two  periods 
alternated,  and  it  was  only  in  her  old  age  that  one  of  the 
two  periods,  the  second, — that  is  to  say  the  better  one, — 
during  which  the  subject  was  more  active  and  had  a 
total  memory,  encroached  upon  the  first  and  filled 
almost  the  whole  of  her  life.  Henceforth  Felida 
seldom  remained  three  or  four  days  in  her  former  state, 
called  normal;  but  then  her  life  was  intolerable,  for 
she  had  forgotten  three-quarters  of  her  existence,  and 
this  gave  rise  to  the  most  comical  situations.  She  feared 
to  pass  for  mad,  and  in  her  anguish  hid  herself  till  a 
new  syncope  restored  her  to  her  better  state,  which 
was  now  her  habitual  one. 

Such  are  the  chief  features  of  this  history,  which  has 
become  celebrated.  You  may  easily  see  wherein  it 
differs  from  the  preceding  observations.  The  sche- 
matic figure  (Figure  5),  which  you  can  now  understand, 
gives  you  quite  a  characteristic  image.  It  is  no  longer 
a  draught-board  on  which  the  periods  of  oblivion  regularly 
alternate  with  the  periods  of  remembrance.  You  see 
regularly  entire  light-coloured  stripes,  which  are  broader 
and  broader  as  life  advances,  in  which  there  is  no  black 
spot;  they  are  the  periods  of  the  state  No.  2,  during 
which  the  memory  extends  over  the  whole  of  life  with- 
out any  amnesia.  On  the  contrary,  in  the  intercalary 
stripes  representing  the  state  No.  i,  you  see  series  of 
black  spots  representing  more  and  more  extended 
amnesias  affecting  the  periods  of  life  which  were  filled 
by  the  state  No.  2.  This  figure  clearly  shows  you  that 
the  two  somnambulisms  are  not  equal,  that  one  is 
superior  to  the  other,  especially  as  regards  the  memory; 


82        The   Major  Symptoms  of  Hysteria 

this  is  what  justifies  the  name  of  dominating  somnam- 
bulisms1 which  I  have  given  to  these  cases. 

If  the  cases  of  the  first  kind,  grouped  around  the 
"Lady  of  MacNish,"  are  rare,  this  is  not  true  of  those 


FIG.  5.  —  Schema  of  the  dominating  somnambulism  in  the  case  of 
Felida  X. 

of  the  second  group,  which  have  Felida  for  type;  the 
case  of  Ladame,  that  of  Verriest  (1888),  of  Bonamaison 
(1890),  of  Dufay  (1893),  and  many  others  could  be 
described  from  the  same  model.  It  is  of  no  use  to 

1  "  The  Mental  State  of  Hystericals,"  translation,  p.  422. 


Double  Personalities  83 

dwell  upon  this.  These  cases  do  not  present  any  really 
new  psychological  phenomena. 

But  it  would  be  well  to  form  a  third  group,  which 
might  be  called  the  group  of  complex  cases,  in  which 
some  celebrated  observations  ought  to  be  placed.  I 
allude  to  the  complicated  cases  of  patients  who  have 
not  two  forms  of  existence,  but  a  very  great  number 
of  forms  of  existence,  as  many  as  nine  or  ten.  These 
different  psychological  states  offer  very  various  rela- 
tions with  one  another;  sometimes  they  are  quite 
independent  of  one  another  and  present  a  simply 
reciprocal  memory;  the  subject  only  finds  again  the 
remembrances  of  the  state  No.  i  when  he  comes  back 
to  the  state  No.  i,  but  he  by  no  means  remembers 
this  state  when  he  is  in  the  state  No.  2  or  in  the  state 
No.  4.  But  such  patients  have  besides,  and  at  the 
same  time,  other  states  obeying  another  rule.  For 
instance,  they  are  apt  to  enter  into  a  particular  state, 
which  we  shall  call  No.  3  in  which  they  not  only  re- 
member the  other  periods  of  the  state  No.  3,  but  also 
remember  the  periods  of  the  state  No.  i  and  of  the 
state  No.  2.  In  a  word,  they  have  reciprocal  som- 
nambulisms and  dominating  somnambulisms. 

One  of  the  most  remarkable  cases  published  in  France 
is  that  of  Louis  Vivet,  studied  from  1882  to  1889  by 
many  authors,  by  Legrand  du  Saulle,  Voisin,  Mabille 
and  Ramadier,  Bourru  and  Burot.  This  boy  has  six 
different  existences.  Each  of  them  is  characterized, 
first,  by  modifications  of  the  memory  affecting  now 
one  period,  now  another;  secondly,  by  modifications 
of  character;  in  one  state  he  is  gentle  and  industrious, 


84        The  Major  Symptoms  of  Hysteria 

in  another  he  is  lazy  and  irascible ;  thirdly,  by  modifi- 
cations of  sensibility  and  of  motion;  in  one  state  he 
is  insensible,  and  paralyzed  in  his  left  side ;  in  another 
he  is  paralyzed  in  his  right  side ;  in  a  third  he  is  para- 
plegic, etc.  An  English  author,  Mr.  Arthur  Myers, 
the  brother  of  the  well-known  psychologist,  in  an  article 
in  the  Journal  of  Mental  Science,  January,  1886,  tried 
to  group  in  a  table  these  four  modifications,  charac- 
terizing each  state.  The  most  curious  fact  of  this  state 
is  that  one  can,  by  acting  on  this  third  character,  bring 
about  the  corresponding  modifications  of  the  other  two. 
If  one  cures  the  paralysis  of  his  two  legs,  one  causes  him 
to  enter  into  the  state  in  which  he  has  all  his  sensations 
and  movements,  and  then  one  sees  the  character  and 
state  of  memory  corresponding  to  this  period  reappear. 
But  these  facts  are  especially  interesting  from  the 
point  of  view  of  the  artificial  reproduction  of  somnam- 
bulisms and  even  of  second  existences.  We  need  not 
dwell  on  them  to-day. 

After  having  reported  this  French  case,  let  us  consider 
some  very  remarkable  American  observations.  One  of 
the  most  astonishing  observations,  whose  scientific  value, 
unfortunately,  I  can  hardly  appreciate,  is  that  which 
was  published  in  1894  under  the  rather  strange  title 
of  "Mollie  Fancher,  the  Brooklyn  enigma;  an  authentic 
statement  of  facts  in  the  life  of  Mary  J.  Fancher,  the 
psychological  marvel  of  the  nineteenth  century;  un- 
impeachable testimony  by  many  witnesses,  by  Abra- 
ham H.  Daily,  1894."  The  history  is  strangely  related ; 
you  feel  in  it  a  kind  of  mystic  admiration  for  the 
subject,  an  exaggerated  seeking  after  surprising  and 


Double  Personalities  85 

supranormal  phenomena,  which  of  course  inspires 
you  with  some  fear  as  to  the  way  in  which  the  observa- 
tion has  been  conducted ;  it  nevertheless  contains  many 
very  remarkable  and  interesting  facts.  Mollie  Fancher, 
who  seems  to  have  had  all  possible  hysterical  accidents, 
attacks,  terrible  contractures  lasting  for  long  years, 
more  or  less  complete  blindness,  etc.,  above  all  pre- 
sented all  the  forms  of  somnambulism,  from  the  simplest 
to  the  most  complicated  ones.  There  are  in  her  at  least 
five  persons,  who  have  very  poetical  pet  names:  Sun- 
beam, Idol,  Rosebud,  Pearl,  Ruby,  each  one  with  her 
.remembrances  and  her  character.  The  complication 
of  this  case  is  very  amusing. 

Lastly,  we  have  to  point  out  the  last  and  most  re- 
markable of  the  observations  of  this  kind,  the  observa- 
tion of  Miss  Beauchamp,  by  Dr.  Morton  Prince,  one  of 
the  physicians  of  Boston  who  have  most  interested 
themselves  in  the  development  of  pathological  psy- 
chology, and  who  devoted  years  of  work  to  the  obser- 
vation of  this  complicated  and  interesting  case.  We 
cannot  here  enter  into  analysis  of  these  complex  cases 
which,  moreover,  are  but  various  combinations  and 
forms  of  the  two  simple  forms  we  have  studied.  In 
these  complex  cases  a  new  influence  usually  makes 
itself  felt  which  complicates  matters  a  great  deal.  I 
mean  the  influence  of  the  observer  himself,  who,  in  the 
end,  knows  his  subject  too  well  and  is  too  well  known 
to  him.  Whatever  precautions  one  may  take,  the 
ideas  of  the  observer  in  the  end  influence  the  develop- 
ment of  the  somnambulisms  of  the  subject,  and  give 
it  an  artificial  complication.  However  it  may  be,  I 


86        The  Major  Symptoms  of  Hysteria 

must  add  the  study  of  these  complex  cases  to  the  two 
simple  forms  I  have  pointed  out,  in  order  to  make  you 
understand  all  the  developments  which  may  be  taken 
by  this  strange  phenomenon  of  multiplex  personality 
in  hystericals. 

Ill 

We  cannot  enter  into  the  psychological  study  of  all 
the  problems  raised  by  the  double  existences  of  hys- 
tericals. Besides,  I  have  pointed  out  to  you  some 
works  published  in  this  very  city,  in  which  you  would 
find  these  discussions  very  well  conducted.  I  only 
wish,  before  concluding  this  lecture,  to  give  you  a  few 
indications  as  to  the  direction  which,  in  my  opinion, 
these  studies  should  take,  and  as  to  a  general  concep- 
tion of  these  apparently  mysterious  phenomena. 

Let  us  take  up  one  more  observation  of  a  double 
personality,  which  differs  from  the  preceding  ones 
only  by  a  singular  slight  detail ;  namely,  that  it  was,  for 
a  great  part,  produced  artificially.  Long  ago,  in  1887, 
a  young  woman  of  twenty,  whose  name  was  Mar- 
celine,  entered  the  hospital  in  a  lamentable  state. 
For  several  months  past  she  had  not  taken  any  food ; 
first,  because  she  obstinately  refused  to  eat,  then  because 
she  immediately  vomited  any  food  or  drink  one  forced 
her  to  swallow.  Besides,  she  no  longer  had  any  func- 
tion of  evacuation;  she  was  incapable  of  urinating 
spontaneously,  and  sounding  alone  could  cause  her  to 
discharge  a  few  drops  of  urine.  In  these  conditions, 
this  young  woman,  who  had  reached  the  last  stage  of 
emaciation,  seemed  to  have  but  a  breath  of  life  left; 


Double  Personalities  87 

she  remained  constantly  lying  in  her  bed,  being  inca- 
pable of  standing.  Her  mental  activity  was  as  much 
reduced  as  her  physical  activity;  she  was  completely 
insensible  on  the  whole  surface  of  her  skin  and  on  all 
her  mucous  membranes;  she  heard  very  badly,  and 
saw  but  exceedingly  little.  Though  she  looked  intelli- 
gent, she  replied  with  great  indifference  to  the  ques- 
tions put  to  her,  and  seemed  to  be  in  a  serious  state 
of  stupefaction.  As  we  did  not  succeed  in  nourishing 
her  otherwise,  we  had  to  try  the  effect  of  hypnotic 
practice. 

After  some  attempts,  we  easily  caused  her  to  enter 
into  a  singular  state,  which  appeared  momentary 
and  artificial,  but  differed  altogether  from  the  habitual 
state  in  which  we  had  constantly  seen  her  since  her 
entrance  into  the  hospital.  She  looked  quite  trans- 
formed physically  and  morally.  She  was  now  capable 
of  moving,  she  accepted  any  food,  and  had  no  longer 
any  vomiting.  Lastly,  she  urinated  spontaneously, 
without  difficulty.  On  the  other  hand,  she  had  become 
sensitive  over  her  entire  body,  and  could  hear  and  see 
perfectly ;  she  expressed  herself  much  better,  with  more 
vivacity,  and  showed  a  complete  memory  of  all  her 
anterior  life.  After  having  nourished  her  in  this  new 
state,  we  thought  it  necessary  to  awaken  her,  since  this 
state  was  considered  artificial.  She  immediately  fell 
back  into  her  preceding  state.  Inert,  insensible,  unable 
to  eat  or  urinate,  she  simply  presented  one  more  dis- 
turbance; namely,  according  to  the  law  of  somnam- 
bulisms, which  you  know,  she  had  quite  forgotten  what 
had  happened  during  the  preceding  period. 


88        The  Major  Symptoms  of  Hysteria 

Nevertheless,  thanks  to  these  artificial  somnambu- 
lisms, we  were  able  to  nourish  her  and  cause  her  to 
recover  her  strength.  But  it  was  always  impossible 
to  make  her  eat  in  the  period  considered  normal,  which 
we  always  brought  back  by  awakening  her.  So  that, 
tired  of  thus  putting  her  to  sleep  at  each  meal,  which 
was  very  long,  we  left  her  for  whole  days  in  the  artificial 
state.  The  only  result  was  apparently  a  great  advan- 
tage, since  all  day  she  ate  well,  urinated  completely, 
and  presented  more  sensibility,  memory,  and  activity. 
One  day  her  parents,  finding  her  in  this  fine  artificial 
state,  considered  her  cured,  and  took  her  out  of  the 
hospital. 

Everything  went  well  during  the  first  days ;  but,  after 
a  few  weeks,  on  the  occasion  of  her  menstrual  period, 
she  experienced  a  kind  of  upsetting,  and  awoke  spon- 
taneously, that  is  to  say,  she  suddenly  returned  to  the 
state  of  depression  and  stupefaction  from  which  we 
had  drawn  her,  but  she  presented,  in  addition,  a  for- 
getfulness  bearing,  this  time,  on  whole  weeks.  She 
was  very  much  bewildered  at  finding  herself  in  her 
house  without  understanding  how  she  had  left  the 
hospital,  for  she  did  not  remember  the  events  of  the 
preceding  days.  Besides,  she  again  refused  to  eat,  and 
could  not  urinate.  Marceline  was  brought  back  to 
me,  and,  in  the  presence  of  all  these  disturbances, 
which  were  well  known  to  me,  I  could  do  nothing  else 
but  put  her  to  sleep  again,  or  rather  bring  her  back  to 
her  artificial  state. 

Well,  gentlemen,  things  continued  in  this  way  fc  r  fif- 
teen years.  Marceline  would  come  to  me  in  order  to  be 


Double  Personalities  89 

put  to  sleep,  enter  into  her  alert  state,  and  then  go  away 
very  happy,  with  complete  activity,  sensibility,  and 
memory.  She  would  remain  thus  for  a  few  weeks; 
then,  either  slowly  or  suddenly,  in  consequence  of 
some  emotion,  fall  back  into  her  numbness,  return 
to  the  state  we  had  considered  primitive  and  natural, 
with  the  same  visceral  disturbances.  The  forgetful- 
ness  now  extended  over  whole  years,  and  disturbed 
her  existence  completely.  She  would  hasten  to  come 
to  me  to  get  herself  transformed  again.  Things  con- 
tinued thus  for  years  together,  till  the  death  of  the 
poor  girl,  who  succumbed  to  pulmonary  tuberculosis. 

How  are  the  two  states  of  Marceline  to  be  explained  ? 
You  see  they  are  quite  like  what  we  have  just  de- 
scribed in  connection  with  the  dominant  somnam- 
bulisms of  Felida.  The  latter  also  had  two  states, 
one  melancholy  and  incomplete,  in  which  she  had 
great  oblivions ;  the  other,  alert,  in  which  she  found  again 
all  her  sensibility  and  memory.  Marceline  resembles 
her  so  much  that  I  have  already  proposed  to  call  her 
an  artificial  Felida.  We  ought,  then,  to  apply  to  her 
the  conventions  proposed  by  M.  Azam,  as  well  as  by  all 
the  authors,  to  designate  these  two  states.  We  ought 
to  say  that  the  state  No.  i  is  the  state  of  depression  in 
which  we  found  her  at  the  beginning  and  which  looked 
normal ;  that  the  state  No.  2,  a  superadded  or  artificial 
state,  is  the  alert  state  with  complete  memory. 

Well,  these  denominations  seem  to  me  quite  incorrect 
when  applied  to  this  case,  which  I  followed  so  long.  It 
is  absurd  to  call  state  No.  i,  —  a  state  of  mental  depres- 
sion incompatible  with  life,  —  a  natural  state ;  it  is  un- 


90        The  Major  Symptoms  of  Hysteria 

likely  that  this  young  woman  has  always  been,  from  the 
first,  in  such  a  state.  In  reality,  it  is  false :  she  began 
by  having  in  her  girlhood,  before  puberty,  all  these  sensi- 
bilities, all  these  functions  at  her  disposal.  She  ate 
and  digested  very  well,  and  urinated  spontaneously. 
This  is  the  real  state  No.  i.  There  is  no  doubt  on 
this  point.  The  state  in  which  we  saw  her  in  the 
hospital,  with  all  her  disturbances  and  insensibilities, 
is  an  abnormal  state  brought  on  by  illness,  by  hysteria, 
which  had  evolved  since  her  puberty.  It  is  the  state 
No.  2. 

But  what  shall  we  do,  then,  with  the  state  obtained 
through  hypnotism,  which  was  produced  artificially? 
Is  it  a  state  No.  3  ?  By  no  means.  In  this  state  her 
functions  were  normal;  she  recovered  the  sensibility 
and  memory  she  had  formerly  had.  I  see  no  reason 
why  we  should  distinguish  this  state  from  the  natural 
state  of  her  childhood,  which  we  called  state  No.  i. 
It  is  simply  a  momentary  cure,  which  we  brought 
about  through  processes  of  artificial  excitation.  And 
when  she  falls  back  into  the  state  No.  2  it  is  simply 
because  the  disease  begins  again. 

All  this  history  may  be  represented  by  the  following 
diagram.  Slowly,  without  its  being  perceived,  this 
young  girl  grew  worse  every  day;  she  had  gradually 
lost  sensibility  and  memory.  We  may  represent  this 
stage  by  a  line  which  descends  well  below  the  line  AB 
of  normal  activity  (Figure  6).  When  she  has  been  hyp- 
notized in  C,  she  rises  again  to  a  state  of  almost  normal 
activity  in  D.  Through  the  effect  of  illness,  she  gradu- 
ally redescends.  At  first  she  seems  to  awaken  a  little 


Double  Personalities 


91 


as  soon  as  you  leave  her,  and  forgets  what  you  have 
just  now  told  her,  E.  Then,  two  days  after,  she  wakes 
again,  F,  that  is  to  say,  she  experiences  a  fall  into  a 
state  of  hysterical  anesthesia  and  amnesia  still  deeper 
than  before,  G;  she  forgets  the  two  preceding  days. 


*-..yc 


FIG.  6.  —  Diagram  of  the  oscillations  of  mental  level  in  the  case  of 
Marceline. 

Then  she  goes  down  very  slowly.  If  you  let  her  fall 
again  by  an  emotion,  for  instance,  there  will  be  complete 
amnesia  of  the  whole  preceding  period.  If  you  excite 
her,  there  will  be,  on  the  contrary,  a  psychological  state 
far  more  complete,  and  a  total  remembrance  of  the 
preceding  periods.  It  is  these  falls,  these  returns  to 
anesthesia,  which  give  to  the  normal  periods  the  aspects 
of  somnambulisms.1 

I  think  it  is  absolutely  the  same  with  all  such  cases, 
that  everything  has  been  confused  through  false  de- 
nominations. Felida  also  had  in  her  childhood  a 
state  No.  i,  which  now  no  longer  exists,  except  in  her 
periods  of  alert  state,  improperly  called  state  No.  2. 
It  has  been  noticed  with  astonishment  that,  at  the  end 
of  her  life,  this  state  exists  almost  alone;  it  is  simply 
because  the  hysteria  is  cured,  and  she  returns  to  the 
normal  state  of  her  girlhood,  which  she  ought  always 

1  "The  Mental  State  of  Hystericals,"  translation,  p.  449. 


92        The  Major  Symptoms  of  Hysteria 

to  have  kept.  There  is  nothing  abnormal  but  the  state 
of  depression  with  amnesia,  which  settled  gradually 
after  her  puberty,  and  which  was  mistaken  for  a  state 
No.  i,  because  it  had  lasted  for  a  long  time  when  the 
subject  was  observed. 

In  this  view  things  become  somewhat  clearer;  the 
essential  phenomenon  that,  in  my  opinion,  is  at  the 
basis  of  these  double  existences,  is  a  kind  of  oscilla- 
tion of  mental  activity,  which  falls  and  rises  suddenly. 
These  sudden  changes,  without  sufficient  transition, 
bring  about  two  different  states  of  activity:  the  one 
higher,  with  a  particular  exercise  of  all  the  senses  and 
functions ;  the  other  lower,  with  a  great  reduction  of  all 
the  cerebral  functions.  These  two  states  separate  from 
each  other;  they  cease  to  be  connected  together,  as 
with  normal  individuals,  through  gradations  and 
remembrances.  They  become  isolated  from  each  other, 
and  form  these  two  separate  existences.  Here,  again, 
there  is  a  mental  dissociation  more  complicated  than 
the  preceding  ones.  There  is  dissociation,  not  only 
of  an  idea,  not  only  of  a  feeling,  but  of  one  mental  state 
of  activity. 


LECTURE  V 

CONVULSIVE  ATTACKS,  FITS  OF  SLEEP,  ARTI- 
FICIAL SOMNAMBULISMS 

A  great  number  of  convulsive  attacks  and  of  fits  of  sleep 
are  nothing  but  imperfect  somnambulisms  —  The  associa- 
tion of  ideas  in  the  hysterogenic  points  —  The  diagnosis  of 
hysterical  and  epileptical  fits —  The  crisis  of  emotional 
manifestation  —  The  different  fits  of  sleep,  the  lethargies  — 
The  perseverance  of  thought  during  this  sleep,  the  crisis  of 
revery  —  The  artificial  reproduction  of  hysteric  accidents, 
of  attacks,  of  fits  of  sleep  —  Artificial  somnambulism  or 
hypnotism  —  The  hypnogenic  points  —  The  hypnotic 
state  as  a  reproduction  of  hysteric  somnambulism 

ALL  the  preceding  examples  —  the  study  of  monoideic 
and  polyideic  somnambulisms,  the  study  of  fugues  and 
of  double  existences  —  showed  you  the  considerable 
importance  assumed  by  somnambulisms  in  hysteric 
neurosis.  We  should  still  have  many  forms  of  the  same 
phenomenon  to  consider.  But  to-day  I  wish  only  to 
dwell  on  certain  elementary  and,  in  some  manner, 
degraded  forms  of  somnambulism,  because  they  are 
common,  because  they  are  to  be  met  with  every  day,  and 
because  it  is  necessary,  in  order  to  understand  them,  to 
be  able  to  connect  them  with  the  more  typical  somnam- 
bulism, of  which  they  are  only  inferior  forms.  You 
will  understand  the  interest  of  this  study,  if  you  notice 

93 


94        The  Major  Symptoms  of  Hysteria 

that  it  first  applies  to  two  phenomena  very  important 
in  practice,  —  convulsive  attacks  and  fits  of  sleep. 

I  hasten  to  tell  you  that  I  do  not  vaguely  connect  all 
hysteric  attacks  and  all  fits  of  sleep  with  phenomena 
of  somnambulism.  The  words  "attack"  and  "sleep" 
are  vague  words,  borrowed  rather  from  the  vulgar 
than  from  scientific  language,  and  very  varied  phe- 
nomena are  ranged  under  them.  You  will  soon  see, 
on  the  occasion  of  motor  agitations,  that  the  hysteric 
attack  is  often  constituted  by  an  ensemble  of  tics,  of 
choreic  movements,  connected  together  in  a  certain 
manner.  Sometimes  fits  of  sleep  are  simply  paralytic 
phenomena;  the  subject  is  incapable  of  moving,  but 
hears  and  understands  very  well  and  has  no  intellec- 
tual disturbance.  So  we  shall  meet  later  on  with  many 
other  forms  of  attacks  and  fits  of  sleep,  but  to-day  we 
are  to  study  one  of  the  most  essential  forms,  in  which 
these  two  accidents  are  nothing  but  particular  aspects 
of  certain  imperfect  somnambulisms. 


Convulsive  attacks,  which  we  have  first  to  attend  to, 
are  exceedingly  frequent  phenomena ;  they  were  noted 
even  by  the  philosophers  and  doctors  of  ancient  Greece. 
It  is  this  phenomenon  that  the  Middle  Ages  and  the 
Renaissance  reproduced  in  the  documents  relating  to 
exorcisms.  Modern  authors,  such  as  Briquet,  state  in 
their  statistics  that  three-quarters  of  their  patients  have 
attacks. 

At  first  sight,  the  patients,  who  seem  to  have  become 


Convulsive  Attacks  95 

unconscious,  and  writhe  in  disorderly  convulsions, 
appear  to  be  very  different  from  the  somnambulists 
we  have  just  studied.  Complete  somnambulism  was 
evidently  characterized  by  a  great  number  of  intelli- 
gent manifestations;  the  subject  expressed  his  idea, 
his  dream,  by  his  adjusted  movements,  which  usually 
are  to  our  mind  the  expression  of  reasonable  thoughts. 
The  first  and  clearest  of  these  expressions  was  speech, 
and  we  had  no  great  merit  in  guessing  the  subject  of 
such  dreams,  since  the  patient  expressed  it  himself 
by  language.  When  he  did  not  speak,  he  had  ex- 
pressions of  the  physiognomy,  attitudes,  and  especially 
acts,  the  interpretation  of  which  was  very  clear;  he 
was  seen  to  get  up,  to  walk,  to  seek  for  objects  in  a 
drawer,  to  make  the  gesture  of  holding  a  revolver  and 
pulling  the  trigger,  to  struggle  with  phantoms,  etc. 
In  a  word,  the  outer  expression  of  the  somnambulic 
idea  was  as  clear  as  possible.  There  is  nothing  of 
the  kind  in  convulsive  attacks,  in  which  the  subject 
seems  to  writhe  in  great,  irregular,  apparently  meaning- 
less movements. 

Yet  it  is  easy  to  prove  that,  from  many  points  of 
view,  these  convulsive  attacks  approach  somnam- 
bulisms. These  accidents,  though  apparently  con- 
stituted by  uncoordinated  movements,  have  the  same 
moral  causes  as  somnambulisms ;  they  begin,  like  them, 
on  the  occasion  of  particularly  affecting  events,  genital 
perturbations,  sorrows,  fears,  etc.  A  man  begins  to 
have  crises  of  hysteria  because  he  has  seen  his  son  fall 
from  a  scaffolding  and  die  before  him;  many  girls 
or  women  begin  to  have  attacks  on  the  occasion  of  the 


96        The  Major  Symptoms  of  Hysteria 

death  of  a  beloved  person;  in  about  ten  observations, 
the  cause  of  the  first  fit  is  a  conflagration,  a  petroleum 
lamp  setting  the  subject's  dress  on  fire;  in  others,  it 
is  a  fall  from  a  tram  car  or  from  a  bicycle,  a  fight  with 
comrades,  heart-grief,  reverses  of  fortune,  etc.  I  wish 
to  dwell  only  on  one  story,  that  of  the  woman  with  the 
dog,  which  affords  a  fine  example  of  attacks  displaying 
the  form  of  imperfect  somnambulism,  joined  with  tics, 
to  which  we  shall  allude  later  on.  This  lady,  forty- 
three  years  old,  who  had  always  been  impressionable, 
of  course,  was  already  very  much  upset  by  the  death 
of  a  very  dear  friend ;  she  had  kept  only  one  souvenir 
from  him,  a  very  precious  souvenir,  an  old  dog.  Now, 
two  years  after  his  master's  death,  the  dog  died,  in  his 
turn,  on  a  carpet.  This  lady,  in  despair,  lay  down  on 
the  carpet  on  which  the  dog  had  died,  and  remained 
there  for  sixty  days  without  consenting  to  accept  any 
food  or  to  take  any  care  of  herself.  From  that  time  she 
began  to  have  terrible  fits  of  hysteria,  which  assumed 
many  forms.  You  see  by  this  example  that  the  start- 
ing-point of  convulsive  attacks  is  the  same  as  that  of  the 
preceding  somnambulisms. 

Let  us  go  one  step  farther  and  consider  the  occasional 
cause  that  determines  the  appearance  of  each  new 
attack ;  it  is  easy  to  see  that  here,  again,  moral  causes 
play  an  important  part.  It  is  true  the  patient  main- 
tains that  the  fit  occurs  irregularly,  without  her  know- 
ing why,  and  that  it  is  brought  on  solely  by  physical 
causes.  There  may  be  some  truth  in  the  remark  that 
the  time  which  has  elapsed  since  the  last  attack  plays 
a  great  part.  When  patients  have  just  had  their  fit 


Convulsive  Attacks  97 

of  somnambulism  or  convulsions,  they  cannot  always 
begin  a  new  attack  immediately.  They  seem  to  be 
modified,  and  to  have  become  less  sensitive  to  the  vari- 
ous moral  impressions;  a  certain  time  must  elapse  — 
two  days  for  one,  a  week  or  a  month  for  another  —  be- 
fore they  become  very  impressionable  and  capable  of  re- 
commencing the  same  phenomenon.  This  is  true ;  we 
meet  here  with  a  very  interesting  periodical  oscillation, 
which  we  shall  have  to  take  into  account  at  the  end  of 
this  course  of  lectures.  But  besides  this  general  pre- 
disposition, it  is  none  the  less  true  that  a  thousand 
accidental  circumstances  bring  about  the  appearance 
of  the  fit.  First  of  all,  slight  exterior  phenomena 
may  produce  this  effect.  The  sight  of  a  flame,  some- 
times of  a  match  only,  brings  about  the  fit  with  those 
subjects  who  have  been  affected  by  a  conflagration; 
any  cry,  or  name,  or  sentence,  will  call  it  back  with 
others.  Our  woman  with  the  dog  is  admirable  in  this 
respect:  it  is  enough  that  a  dog  barks  in  the  street, 
she  sees  a  cat  pass  by,  the  name  of  one  of  the  animals 
is  pronounced,  or  even  certain  words  are  pronounced, 
the  use  of  which  she  absolutely  forbids,  as  the  words 
"love,"  "affection,"  "happiness,"  etc.  It  is  enough 
that  a  date  on  the  calendar  be  mentioned  before  her, 
for  the  fear  of  remembering  a  certain  date  has  caused 
her  to  forbid  all  possible  dates.  The  least  thing  is 
enough  to  bring  about  an  endless  fit,  in  which  convul- 
sions and  howlings  mingle  together  for  fifteen  or  twenty 
hours.  Is  it  not  obvious  that,  in  all  such  cases,  there 
is  an  association  of  ideas  between  the  dreaded  percep- 
tion and  the  remembrances  which  bring  on  the  fit  as 


98        The  Major  Symptoms  of  Hysteria 

well  as  the  somnambulism?  The  different  terms  of 
these  systems  of  ideas  are  connected  together  in  such 
a  manner  that  they  mathematically  call  up  one  another. 
You  would  perhaps  find  it  more  difficult  to  recognize 
the  same  law  if  you  considered  attacks,  the  starting- 
point  of  which  seems  to  be  the  touch  or  excitation  of 
a  point  of  the  subject's  body.  You  know  that  formerly 
great  importance  was  attributed  to  such  points,  which 
were  called  hysterogenic  points.  Charcot  and  Pitres 
wrote  a  long  disquisition  about  them,  which  nowadays 
seems  to  contain  many  errors.  It  was  admitted  that 
the  fit  began  with  a  pain  or  a  strange  sensation  situated 
at  such  or  such  a  point  of  the  body ;  the  most  frequent 
points  with  women  were  the  lower  region  of  the  abdo- 
men, called  the  ovarian  region,  on  either  side.  Pains  at 
this  point  at  the  moment  of  the  fit  were  so  frequent 
that  they  even  determined  the  theories  of  the  ancients 
on  hysteria.  You  remember  the  absurd  story  invented 
by  Plato,  which  spread  all  over  the  world,  obnubilating 
the  minds  of  physicians  for  centuries,  and  casting  a 
kind  of  shame  on  all  such  patients.  It  was,  he  said, 
the  overexcited  matrix  which  required  satisfaction, 
and  as  this  satisfaction  was  not  obtained,  it  Ascended 
through  the  body  as  far  as  the  throat  of  the  patients 
and  choked  them.  In  fact,  this  sensation  of  uneasiness, 
which  often  begins  in  the  lower  part  of  the  abdomen, 
seems  to  ascend  and  to  spread  to  other  organs.  For 
instance,  it  very  often  spreads  to  the  epigastrium,  to 
the  breasts,  then  to  the  throat.  There  it  assumes 
rather  an  interesting  form,  which  was  for  a  very  long 
time  considered  as  quite  characteristic  of  hysteria. 


Convulsive  Attacks  99 

The  patient  has  the  sensation  of  too  big  an  object, 
as  it  were,  a  ball,  rising  in  her  throat  and  choking  her. 
She  makes  an  effort  either  to  swallow  or  to  expel  this 
big  object.  Other  points  and  sensations  may  intervene, 
irregularly  situated  in  the  breast,  shoulders,  eyes,  or 
head,  and  they  seem  to  depend  on  purely  physical 
phenomena. 

Do  not  misunderstand  the  nature  of  such  points. 
First,  they  never  correspond  to  real  organic  lesions,  or, 
at  least,  if  there  are  any  lesions,  they  play  no  part  in 
hysteria,  properly  so-called.  Then,  in  spite  of  appear- 
ances, try  to  realize  thoroughly  that  these  sensations 
are  moral,  not  physical, '  and  that  they  also  depend  on 
the  ideas  and  emotions  of  the  subject.  For  you  must 
not  forget  that  the  different  regions  of  our  body  par- 
ticipate in  all  the  events  of  our  life  and  in  all  our  senti- 
ments. Let  us  consider  two  individuals,  both  of  them 
wounded  in  the  shoulder,  one  by  an  elevator,  the  other 
by  an  omnibus.  These  wounds  have  long  been  cured, 
but  you  can  easily  understand  that  the  remembrance 
of  a  sensation  in  the  shoulder,  that  even  the  idea  of 
the  shoulder,  is  a  part  of  the  remembrance  of  the  acci- 
dent ;  it  is  enough  that  you  touch  one  of  these  patients 
on  the  shoulder  for  this  peculiar  sensation  to  remind 
him  of  his  accident  and  determine  the  crisis.  The  idea 
of  consumption,  the  fear  of  the  phthisis,  is  accompanied 
by  a  certain  painful  sensation  in  the  summit  of  the  left 
lung,  on  the  occasion  of  which  it  began.  The  same 
sensation  located  in  this  spot  will  be  the  starting-point 
of  the  fit.  In  amorous  emotions,  unless  we  have  to 
deal  with  pure  spirits,  there  are  genital  sensations  with 


ioo      The  Major  Symptoms  of  Hysteria 

a  swelling  of  the  region.  What  difficulty  is  there  in 
understanding  that  in  all  these  emotions  of  regret, 
of  love,  of  remorse,  this  image  of  a  physical  sensation 
intervenes  and  plays  the  part  of  a  starting-point  ?  Add 
to  this  the  innumerable  associations  of  ideas  determined 
by  the  habits  of  the  patient  or  the  questions  of  the 
physician.  And  do  not  forget  that  those  pretended 
hysterogenic  points  are  merely  spots  in  which  certain 
peculiar  sensations  easily  arise,  associated  with  the 
remembrance  of  an  affecting  event. 

Let  us  now  pass  on  to  the  end  of  the  fit,  and  you  will 
meet  with  one  more  essential  phenomenon  of  somnam- 
bulism: the  subject,  after  more  or  less  protracted 
struggling,  seems  to  wake  up  all  at  once  or  gradually, 
sets  her  dress  to  rights,  and,  almost  without  any  diffi- 
culty, gets  up  again  and  resumes  her  occupations. 
Here  is  to  be  noticed  a  great  medical  fact ;  namely,  that 
the  hysteric  fit  does  not  seem  to  bring  about  a  great 
physical  disturbance,  as  the  epileptic  fit  does.  The 
subject  is  not  exhausted;  she  has  not  the  stupefied, 
haggard  aspect  of  an  awaking  epileptic,  nor  the  irre- 
sistible need  of  sleep  which  characterizes  the  comitial 
fit.  Our  hysteric  patient,  after  howling  for  several 
hours,  feels  rather  comfortable;  she  experiences,  as  it 
were,  a  relaxation,  and  declares  she  is  much  better  than 
before  the  fit.  Another  characteristic  phenomenon  is 
that  she  attaches  no  importance  to  what  has  happened ; 
she  is  not  in  the  least  ashamed  of  her  cries,  her  indecent 
attitudes,  the  disorder  of  her  acts.  She  seems  to  have 
forgotten  everything,  and  in  truth  remembers  only  the 
facts  previous  to  the  fit;  all  that  has  occurred  after 


Convulsive  Attacks  101 

the  sensations  of  choking  and  the  ascent  of  the  ball  no 
longer  exists  for  her.  This  oblivion  is  very  important ; 
no  doubt  it  is  more  or  less  profound,  according  as  the 
hysteria  is  more  or  less  characterized,  but  it  is  a  part  of 
the  disease.  Beware  of  crises  of  violent  agitation  in 
which  there  is  no  loss  of  consciousness  and  of  which 
the  subject  keeps  an  accurate  remembrance.  Do  not 
inconsiderately  call  that  hysteria;  it  is  nearly  always 
something  else.  In  the  most  favourable  cases,  you  have 
to  deal  with  the  crises  of  agitation  of  the  psychasthenic. 
Unfortunately,  you  have  often  to  deal  with  mental 
disturbances  the  diagnosis  of  which  is  more  or  less  easy. 
I  would  only  insist  on  the  fact  that  our  fit  of  real  hysteria 
ends  with  an  oblivion  like  somnambulism  itself. 

Let  us  now  return  to  the  facts  constituting  the  fit 
itself.  They  are  first  meaningless  movements.  The 
patients  grow  stiff,  then  seem  to  try  still  to  exaggerate 
this  extension  by  throwing  back  the  head,  by  raising 
the  abdomen,  by  "making  a  bridge,"  according  to 
the  usual  expression ;  the  head  is  agitated  in  one  direc- 
tion or  the  other,  the  eyes  closed,  or  open  with  an  ex- 
pression of  terror,  the  mouth  distorted.  Now  the 
patients  grind  their  teeth,  but  without  biting  their 
tongue ;  now  they  open  their  mouth  and  utter  piercing 
cries  in  every  tone.  The  arms  are  agitated  in  every 
direction ;  they  strike  at  haphazard  on  the  surrounding 
objects  or  on  the  breast;  the  fists  alternately  close  or 
open.  The  breathing  is  loud,  irregular,  the  heart 
beats  quickly,  the  face  is  congested,  without,  however, 
being  violet-hued,  as  in  the  epileptic  fit.  It  all  seems 
very  disorderly  and  unintelligible. 


IO2      The  Major  Symptoms  of  Hysteria 

There  is,  however,  a  comparison  which  at  once  comes 
to  our  mind,  and  which  is  very  clearly  indicated  in  the 
old  work  of  Briquet.  "A  fit  of  simple  hysteria,"  he 
said,  "is  nothing  but  the  exact  repetition  of  the  dis- 
turbances by  which  vivid  and  painful  moral  impres- 
sions are  manifested.1  ...  I  choose  as  an  example 
what  happens  to  a  somewhat  impressionable  woman  ex- 
periencing a  sudden  and  vivid  impression.  This  woman 
at  once  has  constriction  in  the  epigastrium,  she  feels 
some  difficulty  in  breathing;  something  rises  to  her 
throat  and  chokes  her;  lastly,  she  feels  in  all  her  limbs 
an  uneasiness  which  causes  them  to  fall,  or  she  feels 
an  agitation,  a  need  of  movement  which  causes  her 
to  contract  her  muscles.  This  is  the  exact  model  of 
the  most  common  hysteric  accident,  of  the  most  usual 
hysteric  spasm." 2 

This  general  conception  applies  very  well  to  the 
greater  purt  of  convulsive  fits.  It  is  easy  to  verify  the 
assertion  that  this  crisis  is  in  fact  an  ensemble  of  emo- 
tional manifestations.  In  many  cases  it  is  even  possi- 
ble to  distinguish  and  recognize  the  particular  emotion 
thus  expressed.  Certain  patients  plainly  manifest 
anger;  they  strike,  scratch,  bite,  and  their  cries  are 
menacing;  others  evidently  have  crises  of  grief  and 
despair,  their  tears  and  meanings  have  quite  another 
meaning  than  the  cries  of  the  former.  It  is  not  very 
difficult  to  recognize  erotic  crises  with  the  latter,  for 
they  play  certain  scenes  in  a  remarkable  manner. 
With  the  former,  on  the  contrary,  much  oftener  you 

1  Briquet,  "Traite  de  1'hyste'rie,"  1859,  p.  397. 

2  Id.,  ib.,  p.  4. 


Convulsive  Attacks  103 

have  crises  of  fear;  the  bewildered  expression  of  the 
eyes,  the  movements  of  defence  of  the  arms  stretched 
forward,  the  drawing  back  of  the  body,  are  quite 
characteristic. 

Besides,  nearly  all  these  patients,  though  they  do 
not  speak  clearly,  as  in  somnambulisms,  mingle  some 
words  with  their  cries,  and  you  easily  distinguish  the 
one  who  calls  "Gaston"  or  "Oscar,"  with  tender 
words,  and  the  one  who  howls,  "Mamma,  help!" 
In  many  cases,  indeed,  the  phenomenon  may  be  said 
to  be  intermediate;  the  subject  speaks  a  little  more, 
her  movements  are  less  incoordinate  and  somewhat 
more  expressive.  These  phenomena  are  almost  som- 
nambulisms, analogous  to  the  preceding  ones,  but  less 
perfect.  The  crisis  of  the  woman  with  the  dog  un- 
questionably belongs  to  this  mixed  type.  For  long 
hours  together  the  following  phenomena  mingle  together 
and  succeed  one  another;  first,  sobs,  tears  streaming 
down  her  face,  cries  of  despair,  great  movements  of 
the  arms  to  strike  her  breast  and  tear  her  hair,  then 
declamations  about  fate,  which  strikes  without  a  rea- 
son, which  strikes  even  the  best  without  their  having 
deserved  their  lot,  then  recitals  of  mournful  passages 
borrowed  from  such  poets  as  Lamartine  or  Musset :  — 

Vivre  un  jour  sans  elle  me  semblait  la  mort  me'me. 
To  live  one  day  without  her  seemed  to  me  death  itself. 

L'homme  est  un  apprenti ;  la  douleur  est  son  maitre. 
Man  is  an  apprentice;  grief  is  his  master. 

To  these  phenomena,  quite  peculiar  to  somnam- 
bulisms, were  added  somewhat  different  symptoms 


IO4      The  Major  Symptoms  of  Hysteria 

which  we  shall  see  later  on,  when  we  study  the  tics 
of  respiration;  namely,  certain  moanings  or  certain 
monotonous  howlings  which  were  regularly  repeated 
for  hours  together.  This  is  decidedly  a  type  of  mixed 
crisis,  in  which  somnambulisms,  exaggerated  emotional 
manifestations,  and  tics  mingle  together. 

From  all  these  reasons,  which  show  us  the  identity 
of  the  beginning  and  of  the  end,  the  analogy  of  the 
essential  manifestations,  we  can  conclude  that  a  great 
number  of  attacks  are  nothing  but  aborted  somnam- 
bulisms; the  idea,  which  developed  itself  in  somnam- 
bulisms through  expressions  of  the  physiognomy, 
words,  and  acts,  now  only  appears  in  the  inferior  and 
merely  emotional  form,  but  these  expressions  of  emo- 
tion are  enlarged,  disfigured.  They  seem  to  have 
become  simpler,  coarser  than  in  the  normal  state. 
The  emotions  seem  to  have  lost  their  intellectual  aspect 
and  to  have  increased  in  their  visceral  and  motor 
expressions.  They  appear  to  have  fallen  and  become 
inferior. 

II 

We  shall  reach  an  analogous  conclusion  by  examin- 
ing another  equally  frequent  accident  of  hysterL  ; 
namely,  fits  of  sleep.  You  know  what  great  curiosity 
this  symptom  has  always  roused.  For  a  long  time 
people  had  been  amazed  at  seeing  individuals  remain- 
ing quietly  asleep,  in  spite  of  all  efforts  to  awake 
them,  sleeping  on  peacefully  for  hours  and  even  days 
together. 

Such  patients,  who  sleep  for  ten,  fifteen  days,  some- 


Fits  of  Sleep  105 

times  for  months  together,  do  not  all  belong  to  the  same 
variety.  They  differ  in  their  physical  aspect  as  well 
as  in  their  moral  state.  Some  seem  to  have  a  rather 
light  sleep ;  the  subject  moves  from  time  to  time,  changes 
his  position,  mutters  a  few  words.  Others  have  much 
deeper  sleep,  accompanied  with  complete  immobility, 
or  even  with  a  certain  degree  of  stiffness  of  the  limbs. 
In  the  last  stage  this  sleep  assumes  that  aspect  of 
lethargy  which  has  given  rise  to  so  many  superstitious 
fears.  As  indicated  by  the  word,  the  aspect  of  these 
patients  approaches  that  of  a  dead  body.  The  face  is 
of  waxen  paleness,  without  any  expression,  the  eyes 
are  closed,  and  when  one  opens  them,  one  finds  that 
the  pupils  are  dilated  and  that  the  eyes  remain  motion- 
less; the  skin  seems  to  have  grown  cold,  the  visceral 
functions  appear  to  have  much  decreased,  the  breath- 
ing is  superficial  and  rare,  the  beats  of  the  heart  are 
hollow  and  difficult  to  perceive.  It  appears  that  a 
certain  number  of  patients  in  this  state  have  been  mis- 
taken for  corpses  and  that  this  accident  has  given  rise 
to  untimely  interments.  For  my  part,  I  am  always 
surprised  when  I  hear  of  such  mistakes.  None  of 
the  lethargic  people  I  have  had  the  opportunity  of 
seeing  could,  in  my  opinion,  be  the  object  of  any  illu- 
sion; a  little  attention  was  sufficient  to  avoid  this 
absurd  mistake.  First  of  all  it  is  not  true,  at  least  in  the 
rather  numerous  cases  I  have  seen,  that  the  functions 
stop ;  one  cannot  feel  the  pulse,  but,  with  some  atten- 
tion, one  can  always  hear  the  heart ;  if  one  seeks  well, 
one  always  finds  some  manifestations  of  the  breathing. 
Besides,  the  temperature  is  not  very  low,  and  the  skin 


io6      The  Major  Symptoms  of  Hysteria 

never  gives  by  its  contact  the  impression  of  a  cadaveric 
skin.  There  are  even  some  little  peculiar  phenomena 
that  seldom  fail ;  for  instance,  that  slight  tremulousness 
of  the  eyelids  which  is  typical,  the  pupillary  reflex 
either  to  light  or,  oftener  still,  to  pain,  the  change  of 
attitude  if  the  mouth  and  nose  are  closed  and  the  breath- 
ing hindered.  In  a  word,  I  do  not  very  well  under- 
stand how  one  can  mistake  a  hysteric  patient  in  lethargy 
for  a  dead  woman,  and  in  my  opinion  such  mistakes 
imply  great  ignorance.  It  is  necessary,  however,  to 
warn  you  against  this  danger. 

As  I  told  you  at  the  beginning,  I  do  not  think  that 
all  hysteric  fits  of  sleep  are  of  the  same  kind,  any  more, 
indeed,  than  are  all  attacks.  We  shall  resume  this 
question  when  we  have  studied  certain  disturbances  of 
the  visceral  functions  of  hystericals.  To-day  I  wish  only 
to  make  you  understand  one  of  the  most  frequent  forms 
of  these  sleeps,  the  one  which,  it  must  be  acknowledged, 
usually  seems  to  be  the  least  profound  and  serious.  It 
is  to  be  found  with  those  subjects  who  fall  asleep  for 
a  few  hours  and  who  nearly  keep  the  aspect  of  normal 
sleep. 

I  do  not  think  that  in  these  individuals  the  psycho- 
logical phenomena  have  disappeared;  I  do  not  think 
that  their  sleep  is  a  merely  physical  phenomenon.  By 
many  methods  one  can  prove  the  existence  of  thoughts 
that  continue  to  develop  in  their  minds.  First  of  all, 
a  protracted  and  attentive  observation  very  often  shows 
you  slight  signs  connected  with  thoughts.  There  are  a 
few  little  movements  of  the  lips,  as  if  the  subject  wanted 
to  speak,  or  sometimes  smile,  a  few  little  transient  ex- 


Fits  of  Sleep  107 

pressions  of  the  physiognomy,  a  few  little  movements 
of  the  hands.  In  certain  cases,  you  have  quite  the  im- 
pression that  the  patient  chatters  inwardly,  and  that  but 
little  is  wanting  for  you  to  be  able  to  understand  him. 
By  means  of  certain  processes  which  we  cannot  study 
in  detail,  one  can  sometimes  put  one's  self  in  relation 
with  such  subjects ;  by  merely  touching  them,  speaking 
to  them,  it  is  possible  to  attract  their  attention,  and  then 
one  can  question  them  and  obtain  certain  answers. 
Sometimes,  in  the  most  favourable  cases,  the  subject 
will  answer  by  speaking ;  sometimes  he  will  answer  by 
slight  signs  of  the  fingers  or  face.  If  you  take  his  hand 
and  ask  him  to  press  it  in  order  to  say  "yes,"  some- 
times you  obtain  nothing  but  movements  of  the  eyelids 
and  eyebrows:  a  slight  lowering  of  the  eyebrows  will 
mean  "yes,"  their  rising  will  mean  "no."  And  you 
can  thus  penetrate  a  little  into  his  thought.  Lastly, 
in  other  and  more  frequent  cases,  you  will  be  able,  after 
the  crisis  of  sleep,  to  find  again  the  recollection  of  it  in 
states  of  artificially  provoked  somnambulism,  about 
which  I  shall  tell  you  a  few  words  at  the  end  of  this 
lesson. 

By  using  these  various  means,  you  can  ascertain  that 
the  immobility  of  such  patients  is  much  less  physical 
than  moral.  Some  have  in  their  mind  the  fixed  idea  of 
sleep  or  death,  and  they  realize  outwardly  the  attitude 
they  are  thinking  of.  But  many  others  have  ideas  that 
are  not  in  the  least  connected  with  the  sleep.  They 
are  seized  with  a  profound  revery,  in  which  they  contem- 
plate scenes  that  present  themselves  before  them,  or 
indulge  in  an  endless  inward  chattering.  A  girl  of  six- 


io8      The  Major  Symptoms  of  Hysteria 

teen,  who  has  been  terrified  by  a  bull  coming  to  attack 
her,  has  crises  of  sleep,  with  perfect  immobility,  during 
which  she  is  appalled  by  the  hallucination  of  the  bull. 
Another,  aged  thirty-two,  in  despair  at  the  death  of  a 
friend,  relates  to  herself  dismal  stories  about  her  own 
death:  "They  are  going  to  put  candles  near  my  bed; 
they  are  putting  me  in  a  little  deal  coffin ;  my  friends  are 
bringing  white  flowers  to  put  on  my  little  coffin,  which 
is  there,  placed  on  two  chairs — "  and  she  talks  thus 
endlessly.  A  man  of  twenty-five  has  been  much  upset 
by  an  accusation  brought  against  him  by  a  fellow- work- 
man. When  he  meets  with  this  individual,  he  becomes 
motionless,  like  one  petrified,  and  at  last  he  slips  to 
the  ground  and  lies,  as  if  asleep,  for  hours  together, 
talking  inwardly  about  the  accusation  brought  against 
him.  He  fancies  he  is  before  his  employer,  and  defends 
himself  in  every  way,  arguing  in  a  complicated  manner 
as  if  he  were  before  a  court  of  justice. 

It  is  useless  to  remind  you  of  the  fact  that  we  could 
make  concerning  these  sleeps  all  the  remarks  we  have 
made  about  the  beginning  and  the  end  of  the  fits. 
They  are  likewise  originated  by  an  affecting  event,  and 
the  same  part  is  played  by  the  provocative  circumstances, 
which,  by  an  association  of  ideas,  recall  the  initial  event. 
You  have  just  seen  an  example  in  which  sleep  is  provoked 
by  the  sight  of  the  person  who  brought  the  accusation. 
We  could  resume  the  same  discussion  about  certain 
special  points  which  have  been  called  hypnogenic  points. 
In  my  opinion,  these  points  do  not  act  at  all  for  physical, 
but  for  moral  reasons,  because  the  sensations  they  bring 
about  are  associated  with  the  affecting  idea.  At  the 


Fits  of  Sleep  109 

end  of  these  fits  of  sleep,  there  occurs  the  same  awaken- 
ing with  indifference,  and  especially  the  same  oblivion, 
exactly  as  in  somnambulisms. 

You  see,  therefore,  that  these  new  phenomena  do 
not  differ  very  much  from  the  preceding  ones.  How- 
ever, you  remember  that,  in  somnambulisms,  there 
were  intelligible  words,  complex  acts,  and  expressive 
movements;  in  attacks,  the  words  and  acts  had  dis- 
appeared; in  the  fits  of  sleep,  which  we  are  now 
considering,  there  remain  not  even  movements  or  con- 
vulsions. It  seems,  therefore,  that  all  the  phenomena 
of  somnambulism  have  disappeared. 

But  these  missing  phenomena  are  not,  in  my  opinion, 
essential  phenomena.  What  was  most  important  in 
somnambulism  was,  as  I  told  you,  an  idea  persist- 
ing in  consciousness  and  developing  to  an  exaggerated 
degree.  The  development  is  complete  if  it  manifests 
itself  by  emotional  expressions,  by  words  and  acts; 
it  is  much  less  complete  if  nothing  remains  but  the  first 
term;  namely,  the  emotional  agitation;  yet  the  idea 
may  still  persist  and  pervade  immeasurably  the  con- 
sciousness of  the  patient,  without  manifesting  itself 
by  anything  outwardly.  The  subject  is  then  invaded 
by  a  kind  of  meditation  from  which  nothing  can  dis- 
tract him;  he  perceives  no  phenomenon  foreign  to  his 
dream,  and  this  is  the  reason  why  he  cannot  be  awakened 
by  any  means  whatever,  and  takes  on  the  appearance  of 
being  in  a  profound  sleep.  So  we  were  right  in  saying 
that  this  form  of  hysteric  accident  was  also  connected 
with  somnambulism,  of  which  it  was  only  the  last 
degree. 


no      The  Major  Symptoms  of  Hysteria 


III 

I  should  not  like  to  conclude  this  study  of  hysteric 
somnambulisms  without  indicating  to  you  in  its  proper 
place,  if  not  a  new  form,  at  least  an  important  char- 
acteristic of  all  the  preceding  forms.  A  very  curious 
property  of  hysteric  accidents,  which,  no  doubt,  is  not 
absolutely  peculiar  to  them,  but  which,  carried  to  this 
degree,  is  rare,  is  that  they  can  be  artificially  re- 
produced. 

In  most  diseases,  the  accidents  are  not  at  our  disposal. 
To  take  only  one  striking  example,  we  are  not  at  all 
masters  of  an  epileptic  fit;  we  cannot  stop  it  at  will, 
nor  can  we  reproduce  it,  or  make  it  reappear  when  we 
please.  Let  us  take,  for  example,  an  individual  who 
has  been  affected  with  epilepsy  for  ten  or  twenty  years, 
and  who  very  frequently  has  the  most  decided  epileptic 
fits.  Well,  if  we  wished,  for  any  reason,  in  the  interest 
of  the  patient  himself,  to  study  his  epileptic  fit,  if  we 
wished  that  a  fit  might  take  place  in  our  presence  in 
the  laboratory,  where  we  have  the  time  and  the  means 
to  examine  its  details  accurately,  we  could  not,  as  you 
know,  realize  this  wish.  We  can  take  the  patient  before 
us,  try  him  in  every  way,  but  he  will  present  no  patho- 
logic phenomenon.  He  will  not  be  impressionable  at 
all,  he  will  not  have  the  shadow  of  an  epileptic  fit.  An 
hour  afterwards,  when  we  are  gone,  and  without  our 
knowing  why,  he  will  suddenly  fall  and  have  a  great  epi- 
leptic fit.  It  is  a  disease  on  which  experimentation  has 
no  hold.  Formerly  it  was  so  with  three-fourths  of  the 


Artificial  Somnambulisms  1 1 1 

diseases;  nowadays,  owing  to  the  discoveries  of  physi- 
ology, of  microbiology,  and  sometimes  of  psychology,  we 
begin  to  be  able  to  reproduce  in  the  laboratory  some  of 
the  diseases  we  want  to  study.  You  know  that  it  was 
a  revolution  when  Pasteur  demonstrated  that  the  cattle 
plague,  —  the  carbuncle,  —  could  be  given  to  an  animal 
when  one  pleased.  It  is  the  beginning  of  medical 
science,  and  sometimes  of  therapeutics,  to  be  able  thus 
to  bring  about  the  outbreak  of  a  disease  at  will. 

Well,  this  character  is  developed  to  the  highest  degree 
in  hysteric  neuroses,  and  it  applies  especially  to  the 
somnambulisms  of  which  I  have  just  spoken.  Notice 
first  that  it  is  a  constant  symptom  of  monoideic  som- 
nambulisms. We  have  only  to  awaken  in  a  more  or 
less  precise  manner  in  the  mind  of  the  subject  the  idea 
whose  development  fills  up  the  somnambulism,  to  cause 
the  latter  to  reappear.  Sometimes,  to  awaken  such  an 
idea,  it  is  necessary  to  recall  it  completely,  to  describe 
it,  to  dwell  on  the  images  that  constitute  it ;  sometimes 
it  is  sufficient  to  make  a  sign,  to  call  up  a  term  asso- 
ciated with  that  idea,  for  the  rest  of  the  somnambulism 
to  develop,  owing  to  the  automatic  association  which 
you  know.  Speak  of  Pauline  to  that  young  wpman 
who  wanted  to  imitate  her  by  throwing  herself  out  of 
the  window ;  she  will  think  of  the  suicide  of  her  niece, 
go  towards  the  window  and  begin  all  the  scene  over 
again.  Question  Irene  on  the  death  of  her  mother; 
you  will  see  one  of  the  following  different  phenomena : 
either,  as  we  have  noted,  she  understands  the  question, 
only  partially  answers  us  vaguely,  has  no  accurate 
remembrances  relating  to  her  mother's  death,  nor  even 


\i1     The  Major  Symptoms  of  Hysteria 

to  her  illness ;  or,  if  you  insist  a  great  deal,  if  you  remind 
her  of  facts  characteristic  of  the  agony,  the  subject  will 
lose  her  composure,  be  agitated,  and  cease  to  hear  us 
or  see  surrounding  objects.  She  will  soon  be  absorbed 
in  her  dream,  and  then  will  recite  in  a  declamatory 
torie  the  details  of  the  agony  we  spoke  of,  and  begin  to 
play  the  scene  of  the  death  and  of  her  own  attempt 
at  suicide  under  an  engine;  the  somnambulism  has 
begun  again. 

What  we  have  just  said  applies  to  all  the  other  forms 
of  somnambulism;  to  polyideic  somnambulism,  in 
which  the  dream,  when  once  begun,  is  transformed 
by  the  appearance  of  new  circumstances;  to  fugues 
themselves,  which  we  can  make  the  patients  recommence 
by  dwelling  on  the  dominant  idea.  Many  of  the  fugues 
of  young  R.  were  in  some  manner  experimental; 
his  comrades  provoked  them  by  recalling  through  their 
chatter  the  stories  of  travels  which  had  impressed  the 
patient.  Nay,  more,  —  the  fact  is  but  little  known,  — 
double  existences  can  be  experimentally  reproduced. 
Allow  me  to  recall  this  remarkable  observation  on 
which  I  have  often  insisted  already,  that  of  Marceline, 
whom  we  have  just  studied  in  our  preceding  lecture. 
This  patient,  as  you  know,  was  transformed  by  hypno- 
tism and  kept  during  fifteen  years  two  existences,  the 
former  with  depression,  anesthesias,  amnesias,  anorexy, 
etc.,  brought  about  by  the  hysteria ;  and  the  latter  with 
rather  good  health,  normal  sensations,  and  memory  de- 
termined by  artificial  excitation.  She  had  really  become 
a  kind  of  artificial  Felida,  and  she  shows  us  that  double 
existence  itself  can  be  reproduced  by  artificial  means. 


. 
Artificial  Somnambulisms  113 

What  I  have  just  told  you  of  somnambulisms  is  still 
truer  with  respect  to  those  incomplete  forms  of  somnam- 
bulism which  we  have  just  studied  under  the  name  of 
emotional  fits  and  fits  of  sleep  with  revery.  Those  who 
described  the  hysterogenic  and  hypnogenic  points  had 
insisted  on  the  following  character;  namely,  that  at 
any  moment  you  could,  by  the  excitation  of  these  points, 
cause  the  patient  to  fall  back  into  the  attack  or  sleep. 
One  fell  into  convulsions  as  soon  as  her  lower  abdomen 
was  pressed,  the  other  into  a  fit  of  sleep  when  one  of 
her  breasts  was  touched.  We  know  now  what  these 
phenomena  mean ;  they  belong  to  the  same  group  with 
the  preceding  ones.  The  sensation  provoked  is  again 
a  signal  associated  with  the  group  of  psychological 
phenomena  of  the  crisis.  I  shall  only  recall  the  essen- 
tial fact ;  namely,  that  we  can  make  these  phenomena 
reappear  artificially. 

The  states  thus  artificially  reproduced,  the  somnam- 
bulisms especially,  are  not  long  in  being  a  little  modi- 
fied. After  a  certain  time,  they  are  no  longer  quite 
identical  with  the  original,  natural  phenomena.  The 
reason  of  this  is,  as  we  saw  when  we  studied  polyideic 
somnambulisms,  that  new  ideas  may  develop  in  this 
state  without  stopping  it.  An  idea  that  plays  a  great 
part  is  the  idea  of  the  experimenter  who  has  artificially 
provoked  the  state.  The  latter  is  more  and  more  ca- 
pable of  introducing  himself  into  the  somnambulism 
of  the  subject.  At  first  he  can  only  be  understood  by  the 
subject  if  he  speaks  to  her  of  ideas  related  to  the  som- 
nambulic  dream,  but  he  is  soon  himself  a  part  of  the 
dream  and  is  heard  and  understood  if  he  speaks  of  any- 


114      The  Major  Symptoms  of  Hysteria 

thing  whatever.  The  greater  and  greater  influence  the 
experimenter  acquires  over  his  subject  is  not  long  in  trans- 
forming the  somnambulism,  in  giving  it  a  form  and  laws 
that  are  often  strange  and  simply  result  from  the  habits 
of  the  experimenter.  One  teaches  his  subject  always  to 
to  say  "thee,  thou,"  during  the  somnambulic  state, 
whereas  she  says  "you"  in  the  normal  state;  another 
accustoms  her  to  fall  profoundly  asleep  when  her  eyes 
are  touched,  and  to  wake  up  when  her  vertex  is  touched. 
Such  phenomena  were  formerly  presented  as  laws  of 
somnambulism,  and  gave  rise,  at  the  time  of  Charcot, 
to  many  passionate  discussions.  Thus  is  formed  in 
some  subjects  an  artificial  somnambulism,  which  has 
been  given  the  name  of  hypnotism. 

This  hypnotism  raises  one  last  serious  question, 
which  we  cannot  treat  in  detail,  and  on  which  I  con- 
fine myself  to  giving  you  my  personal  opinion.  Is  this 
hypnotism  something  distinct  from  hysteric  somnam- 
bulism? Is  it  something  peculiar,  an  abnormal  state 
independent  of  hysteria?  You  remember  what  great 
battles  have  been  fought  on  that  point.  For  my  part, 
I  do  not  hesitate,  and  these  are  the  principal  reasons 
for  my  opinion :  first,  considered  in  itself,  the  hypnotic 
state  has  never  any  character  which  cannot  be  found 
in  natural  hysteric  somnambulisms.  The  modifica- 
tions it  offers  are  very  easily  explained  as  the  result  of 
education. 

Secondly,  if  you  examine  the  subjects  with  whom 
this  state  can  be  obtained,  you  will  be  convinced  that 
they  are  mostly  hysteric  patients,  having  already  had  som- 
nambulism in  some  form  or  other,  or  for  the  remaining 


Artificial  Somnambulisms  115 

part  hysteric  patients  having  presented  other  acci- 
dents, but  having  the  mental  state  characteristic  of 
hysteria. 

Thirdly,  you  can  verify,  if  you  examine  matters  with- 
out preconceived  ideas,  the  fact  that  subjects  troubled 
with  other  diseases  than  hysteria  —  epileptics,  for  in- 
stance, psychasthenics  tormented  by  the  mania  of  doubt, 
lunatics  affected  with  systematic  delirium  —  are  not  at 
all  hypnotizable,  and  that  one  will  never  be  able  to 
reproduce  in  them  a  real  somnambulic  state  with  com- 
plete consecutive  amnesia. 

Fourthly,  and  I  find  this  remark  very  important; 
this  artificial  somnambulism  is  healed  and  disappears 
in  the  same  manner  as  natural  somnambulisms.  A 
subject  whose  hysteria  decreases,  who  tends  towards 
recovery,  whose  mental  state  changes,  ceases  to  be  hyp- 
notizable. 

Fifthly,  and  lastly,  these  two  states  are  so  analogous 
to  each  other  that  you  can  pass  from  the  one  to  the 
other  by  imperceptible  transitions.  You  can  enter 
into  relation  with  an  individual  in  natural  somnambulism, 
first  speak  to  him  of  his  dream,  get  him  to  listen  to  you, 
then  direct  his  thoughts  and  afterwards  put  him  into 
the  hypnotic  state  at  will.  Inversely,  the  hypnotic  state, 
if  you  do  not  sufficiently  direct  the  mind  of  the  subject, 
can  be  transformed  into  a  state  of '  independent  dream, 
into  a  state  of  hysterical  somnambulism. 

In  a  word,  it  seems  there  is  no  reason  for  making  a 
special  place  for  the  hypnotic  state;  it  is  a  somnam- 
bulism analogous  to  the  preceding  one,  and  differs  from 
it  only  in  that  it  is  obtained  artificially  instead  of  devel- 


n6      The  Major  Symptoms  of  Hysteria 

oping  spontaneously.  So  we  have  passed  in  review 
the  different  forms  of  somnambulic  accidents  that 
characterize  hysteria  and  constitute  more  than  half 
of  the  accidents  of  this  neurosis. 


LECTURE  VI 
MOTOR  AGITATIONS  —  CONTRACTURES 

Disturbances  in  the  motor  functions  of  the  limbs  —  Apparent 
exaggeration  of  motion — The  phenomenon  of  tics  — 
Rhythmical  choreas — The  absence  of  will,  of  consciousness, 
anesthesia  —  The  diagnosis  —  The  tremors  —  The  con- 
tractures  —  Clinical  importance  of  this  accident  —  The 
part  played  by  mental  phenomena —  The  degradation  of 
the  movements  in  these  hysterical  accidents 

HYSTERIC  neuroses,  the  history  of  which  we  are  pur- 
suing, very  often  present  accidents  of  quite  another 
nature,  which  at  first  sight  seem  to  be  different  from 
somnambulisms.  These  accidents  do  not  affect  the 
whole  of  the  body  and  of  the  mind,  like  the  former ;  they 
seem  only  to  disturb  certain  functions,  and,  in  particu- 
lar, the  accidents  we  consider  to-day  appear  only  to 
disturb  the  motor  functions  of  the  limbs.  In  spite  of 
the  disturbances  seated  in  the  arm  or  leg,  the  mind 
may  appear,  at  least  in  certain  cases,  absolutely  intact, 
while  in  somnambulisms  the  delirium  seemed  to 
be  general.  In  the  second  place,  motor  disturbances, 
which  we  now  consider,  are  not  momentary,  but  they 
are  lasting.  Instead  of  appearing,  like  attacks  and 
somnambulisms,  at  determinate  moments,  and  dis- 
appearing in  the  interval,  they  may  last  for  a  long  time, 
for  days  and  months  together,  no  matter  what  the  state 
of  the  subject  may  be.  They  may  exist  during  the  fits 

117 


Ii8      The  Major  Symptoms  of  Hysteria 

and  also  exist  in  the  interval.    So  you  see  that  the  phe- 
nomena are  apparently  pretty  different. 

Yet  most  physicians,  especially  since  the  end  of  the 
last  century,  do  not  hesitate  to  connect  this  ensemble 
of  motor  disturbances  with  the  same  neurosis,  with 
hysteria.  Perhaps  we  shall  be  able  to  justify  this  diag- 
nosis later  on  by  showing  that  the  mental  disturbance 
is  at  bottom  about  the  same  as  in  somnambulisms. 
For  the  present,  we  cannot  ground  our  argumentation 
on  this  still  unknown  character,  and  we  are  obliged 
to  justify  the  diagnosis  of  these  disturbances  of  motion 
by  mere  clinical  remarks.  We  observe  only  that  they 
present  themselves  in  the  same  subjects  and  in  the  same 
conditions  as  the  preceding  somnambulisms.  The 
patients  we  shall  describe  to  you  to-day  who  have  had 
these  perversions  of  motion,  these  agitations  or  paraly- 
ses, are  the  same  whom  we  already  know;  they  had, 
a  short  time  before,  monoideic  somnambulisms,  fugues, 
or  fits.  They  can  still,  if  we  choose,  enter  into  those 
hypnotic  states  which  we  consider  as  the  reproduction 
of  spontaneous  somnambulisms.  In  them,  these  various 
accidents  alternate  with  one  another.  After  a  fit  they 
may  have  spasms  or  paralysis;  inversely,  these  dis- 
turbances of  motion  may  disappear  in  a  new  fit  or  a 
new  somnambulism.  No  doubt,  these  are  not  abso- 
lutely irrefutable  reasons,  and  it  will  be  necessary  to 
complete  the  diagnosis  when  we  know  better  the  nature 
of  these  motor  phenomena ;  but  after  all,  these  reasons 
are  sufficient  to  induce  us,  while  pursuing  the  study  of 
the  hysteric,  to  enter  into  the  examination  of  these 
phenomena  which  these  patients  often  present. 


Motor  Agitations  —  Contractures        119 

The  motor  disturbances  that  have  the  preceding 
characteristic  are  very  various  and  irregular;  we 
could  range  them  in  two  large  groups :  first,  phenomena 
of  at  least  apparent  exaggeration  of  motion,  which  seem 
to  exceed  the  will  of  the  patient  and  to  develop  inop- 
portunely and  without  his  consent,  and  second,  phe- 
nomena of  deficiency,  in  which,  on  the  contrary,  motion 
seems  to  fail  and  not  to  obey  the  will  and  consciousness 
of  the  subject.  In  the  first  group,  which  we  designate 
under  the  general  name  of  motor  agitations,  are  to  be 
ranged  tics,  choreas,  and  contractures ;  in  the  second, 
the  strange  functional  paralyses,  or  paralyses  dependent 
on  ideas ;  to-day  we  shall  study  only  the  first  group. 


You  all  know  the  commonplace  phenomenon  of 
tics,  which  is  to  be  met  under  so  many  circumstances; 
I  advise  you  to  keep  the  French  word  because  I  do 
not  find  in  the  English  language  a  good  translation. 
You  must  not  fancy  that  all  tics  are  hysteric.  There 
are  some  epileptic  tics,  and  even  oftener,  psychasthenic 
tics,  but,  to  confine  ourselves  to  our  preceding  diagnosis, 
there  are  some  tics  that  are  to  be  met  with  in  patients 
who  have  already  had  all  the  preceding  forms  of  som- 
nambulism, and  that  alternate  with  these  somnam- 
bulisms. 

These  tics  are  essentially  constituted  by  little  move- 
ments of  the  face,  head  or  limbs,  which  appear  at 
random,  without  any  relation  either  to  the  present  cir- 
cumstances or  the  consciousness  of  the  patients.  This 


I2O      The   Major  Symptoms  of  Hysteria 

name  is  generally  reserved  for  rather  sudden  little  move- 
ments of  short  duration,  and  other  terms  are  used  when 
the  same  involuntary  movements  have  a  greater  extent. 
These  little  muscular  shakes  may  present  themselves 
in  all  parts  of  the  body.  You  may  especially  notice 
them  in  the  face;  they  constitute  grimaces  of  a  thou- 
sand kinds,  affecting  the  eyes,  the  nose,  the  mouth. 
The  patient  puckers  his  forehead  in  various  ways, 
raises  or  lowers  his  eyebrows,  winks,  looks  sideways 
by  starts ;  he  makes  his  nostrils  tremble,  closes  or  opens 
them  too  much.  A  very  interesting  patient,  whom 
we  shall  study  with  more  detail  to-day,  blows  violently 
through  his  left  nostril.  Others  seem  to  wipe  their 
noses  or  to  sneeze ;  their  lips  suddenly  draw  to  the  one 
side  or  the  other,  stretch  forward  or  shrink  backward,  or 
else  are  continually  bitten  —  the  upper  lip  as  well  as 
the  lower  one.  The  tics  of  the  neck  have  been  brought 
into  notice  by  being  described  under  the  name  of 
psychic  stiff  neck;  involuntarily  and  suddenly  the 
patient  inclines  his  head  towards  one  shoulder,  or  throws 
it  back,  or  bends  it  forward,  or  turns  it  on  its  axis.  He 
repeats  these  movements  every  two  or  three  seconds  in 
a  way  which  it  is  impossible  to  explain  or  justify  by 
any  present  reason. 

I  do  not  speak  now  of  the  tics  related  to  the  visceral 
functions  such  as  the  alimentation  or  breathing  tics; 
I  at  once  pass  on  to  the  tics  of  the  limbs.  In  these 
the  arms,  the  hands,  seem  to  have  taken  strange  habits ; 
they  rise  suddenly  or  move  backwards;  the  shoulders 
are  shaken  convulsively;  the  legs,  instead  of  regularly 
performing  the  act  of  walking,  every  moment  interrupt 


Motor  Agitations — Contractures        121 

it  by  a  strange  little  shake  of  the  knee  or  foot  or  toes. 
These  little  movements,  which  have  innumerable  forms, 
of  course  impede  every  action  of  the  arms,  and  when 
they  occur  in  the  waking  state,  they  often  make  walking 
almost  impossible. 

Let  us  proceed  at  once,  in  order  not  to  interrupt  the 
description,  to  the  same  kind  of  involuntary  and  use- 
less movements  that  have  a  greater  extent  and,  for 
that  reason,  have  been  called  choreas.  This  distinc- 
tion is  not  essential  at  the  bottom,  and  must  not  pre- 
vent us  from  putting  all  the  motor  agitations  in  the 
same  group.  The  first  choreas  that  physicians  decidedly 
connected  with  hysteria  were  the  rhythmical  choreas, 
thus  called  because  the  movements  were  repeated 
regularly  at  determinate  intervals,  like  those  of  a  pen- 
dulum. This  kind  of  rhythmical  movements  occurs 
very  often  in  the  hysteric  fit ;  it  constitutes  those  com- 
plications of  the  simple  fit  which  I  have  pointed  out 
to  you.  Very  often  the  patients,  without  recovering 
consciousness,  cease  their  emotional  manifestations 
to  indulge  in  some  odd  and  perfectly  regular  gymnas- 
tics. 

One  of  the  most  commonplace  is  the  salute,  which 
Charcot  described;  the  patient,  lying  on  her  bed,  sits 
up,  bends  her  head  and  body  forward,  sometimes  low 
enough  to  touch  her  knees,  as  if  she  were  making  a 
salute,  then  suddenly  throws  herself  back  till  her  head 
falls  on  her  bed.  After  a  moment,  she  begins  again; 
she  may  thus  make  this  salute  twenty  or  forty  times  a 
minute  for  hours  together.  Others  have  malleatory 
movements  of  the  arm  or  leg;  you  would  think  they 


122      The  Major  Symptoms  of  Hysteria 

strike  regularly  with  a  hammer.  Others  again  have 
saltatory  movements ;  either  when  lying  or  when  stand- 
ing, they  appear  to  jump  or  dance  regularly.  Besides 
these  definite  classified  movements,  there  are  hundreds 
of  others  which  have  no  definite  name ;  this  one  clinches 
her  fists  and  suddenly  brings  them  together  towards 
the  middle  of  her  body,  then  separates  them,  and  be- 
gins again  indefinitely;  another  turns  her  right  wrist 
as  if  it  were  fixed  to  a  wheel,  and  so  forth  indefinitely. 
In  all  such  acts  there  is  always  the  same  rhythmical 
regularity;  Charcot  quoted,  in  reference  to  this,  the 
sentence  in  Hamlet :  "  Though  this  be  madness,  yet 
there's  method  in  it,"  and  wished  a  ballet-master  might 
observe  and  write  down  the  strange  and  regular  move- 
ments of  the  patients. 

These  movements  have  their  maximum  of  strength 
and  rhythmical  regularity  during  the  fit;  but  it  is 
characteristic  of  the  motor  agitations  we  speak  of,  that 
they  may  very  well  persist  in  the  interval  of  the  fits. 
The  patient  speaks  correctly ;  he  is  in  possession  of  the 
whole  of  his  consciousness,  has  all  his  recollections, 
can  even  execute  movements  with  his  unharmed  limbs, 
but  he  continues  to  make  the  rotary  movement  with 
his  right  hand  and  bring  his  two  hands  into  contact 
or  separate  them. 

Though  the  more  distinct  hysteric  chorea  is  thus 
characterized  by  a  rhythm,  you  must  not  fancy  that 
every  other  chorea  in  which  there  is  no  rhythm  is  neces- 
sarily outside  the  great  neurosis;  that  was  believed 
formerly,  but  this  too  simple  diagnosis  had  to  be  re- 
formed. No  doubt,  a  very  irregular  chorea,  consist- 


Motor  Agitations  —  Contractures        123 

ing  in  characterless  shakes  of  the  arms  and  legs  occur- 
ring without  any  kind  of  regularity  amidst  voluntary 
movements,  is  usually  the  common  chorea,  called 
chorea  of  Sydenham,  with  which  we  have  not  to  deal. 
If,  however,  such  a  chorea  appears  in  adults  or  young 
people  after  their  puberty,  you  must  be  on  your  guard, 
for  such  choreas,  though  arrhythmic,  may  very  well 
depend  on  hysteria.  A  young  woman  thirty-one  years 
old,  terrified  by  an  explosion  in  a  factory  where  she 
worked,  presented  for  more  than  ten  years,  deliriums, 
fits,  somnambulisms  of  all  kinds  which  were  unques- 
tionably hysteric.  Amidst  these  various  accidents, 
taking  their  place  or  alternating  with  them,  she  had 
very  long  periods  of  chorea.  This,  chorea  of  all  the 
limbs  and  of  the  head  presented  no  kind  of  rhythm, 
and  yet  we  do  not  hesitate  to  maintain  that  it  was  a 
hysteric  phenomenon  like  the  other  accidents  of  the 
patient.  We  have  noted  about  twenty  quite  typical 
observations  of  this  kind,  which  clearly  show  that  the 
arrhythmic  chorea  must  be  counted  among  the  possible 
forms  of  hysteric  motor  agitation.  Its  diagnosis  then 
depends  not  only  on  the  previous  and  simultaneous 
accidents,  but  also  on  the  mental  state  which  accom- 
panies it,  and  on  which  we  must  now  insist. 

II 

Whatever  may  be  the  tics  or  choreic  movements 
that  these  patients  present,  you  observe  a  certain  number 
of  psychological  characteristics  accompanying  them, 
which  characteristics  are  the  easier  to  discern  as  these 


124      The  Major  Symptoms  of  Hysteria 

motor  accidents  continue  during  the  waking  state  and 
it  is  possible  to  question  the  subject  about  what  he  feels. 
When  the  movement  thus  exists  during  the  waking 
state,  one  can  better  realize  the  mental  state  that  ac- 
companies it. 

First  of  all  the  will  of  the  subject  has  no  influence 
on  it.  Of  course,  the  subject  asserts  that  he  does  not 
want  at  all  to  make  this  movement,  and  by  all  his 
conduct  shows  us  that  he  would  very  much  like  to  be 
rid  of  it,  but  he  cannot  stop  it  any  more  than  he  can 
produce  it.  The  efforts  of  his  will  appear  powerless; 
by  making  great  efforts  he  can  at  most  disturb  the 
rhythmical  movement,  make  it  less  regular,  complicate 
it  with  shakes  of  the  rest  of  his  body.  The  movement 
is  not  stopped,  and  begins  again  more  regularly  when 
the  subject  gives  up  his  efforts  of  will. 

Consciousness  does  not  seem  to  have  a  great  hold  on 
this  phenomenon  either ;  the  subject  seems  to  be  scarcely 
aware  of  his  tic  or  his  chorea ;  very  often  he  performs 
it  without  knowing  it;  even  when  he  is  attentive,  he 
feels  it  but  little  or  even  not  at  all;  when  he  shuts 
his  eyes,  he  may  very  well  declare  that  now  his  arm 
no  longer  moves  at  all,  while  the  movement  continues 
with  perfect  regularity. 

We  see  those  phenomena  of  insensibility  appear  here, 
which  will  play  a  greater  and  greater  part  in  hysteric 
accidents.  When  treating  of  somnambulism,  we  spoke 
but  little  of  insensibility;  in  the  first  place,  when  the 
somnambulism  is  at  an  end,  this  disturbance  may  fail 
entirely;  a  somnambulist  is  not  necessarily  insensible 
in  the  waking  state ;  he  is  merely  amnesic ;  it  is  amnesia 


Motor  Agitations  —  Contractures        125 

that  is  the  stigma  of  somnambulism,  and  not  anesthesia. 
Then  during  the  somnambulism  itself,  there  is,  it  is 
true,  a  certain  anesthesia,  but  it  is  very  peculiar,  and 
only  affects  the  phenomena  which  are  not  connected 
with  the  subject's  dreams.  When  we  come  to  motor  dis- 
turbances, that  insensibility  which  is  called  hysteric 
anesthesia  begins  to  intervene.  It  may  present  itself 
in  two  ways ;  sometimes  it  is  systematic  and  bears  only 
on  the  movement  that  constitutes  the  tic  or  the  chorea. 
The  subject  does  not  feel  that  he  moves  his  forehead, 
or  that  he  strikes  his  bed  regularly  with  his  hand,  but 
he  feels  the  other  things,  and  in  particular,  is  able  to 
tell  you  that  somebody  seizes  his  hand  while  he  is 
performing  the  choreic  movement.  Notice  this  sys- 
tematic anesthesia,  which  will  become  more  and  more 
important.  Sometimes  the  anesthesia  is  more  impor- 
tant, and  the  whole  of  the  limbs  affected  with  a  tic 
or  a  chorea  is  insensible.  For  instance,  one  of  the  sub- 
jects to  whom  I  alluded  used  to  turn  his  right  hand  in 
a  circle  and  had  a  see-saw  movement  in  his  right  foot ; 
the  whole  of  his  right  side  was  nearly  insensible. 

These  anesthesias,  this  kind  of  unconsciousness, 
must  play  a  certain  part  in  the  diagnosis ;  you  will  not 
meet  again  with  the  same  characteristics  in  the  same 
degree  in  tics  of  another  nature,  particularly  in  the  tics 
of  the  psychasthenic.  With  the  latter,  the  tic,  while 
appearing  involuntary,  is  accompanied  by  a  great  deal 
of  consciousness  and  attention.  The  subject  performs 
his  tic  when  he  thinks  of  it,  when  he  directs  his  atten- 
tion to  the  organ  and  tries  to  keep  it  motionless.  It 
seems  that,  with  these  patients,  attention  increases  the 


126      The  Major  Symptoms  of  Hysteria 

tic  instead  of  diminishing  it.  Inversely,  you  may  ob- 
serve that  distraction  sometimes  has  a  good  effect. 
When  the  subject  forgets  his  disease  and  his  mind  is 
absorbed  by  something  else,  he  leaves  off  performing 
his  tic.  You  see  that  with  him  the  tic  is  conscious,  that 
it  is  in  connection  with  thoughts  the  subject  possesses. 
There  is,  therefore,  no  anesthesia  in  this  case.  The 
subject  feels  his  movement  very  well  and  all  that  passes 
in  the  diseased  limb.  With  the  hysteric,  the  move- 
ment is  impeded  by  attention;  it  develops,  becomes 
more  complete  and  regular  in  a  state  of  distraction;  it 
is  much  oftener  accompanied  with  anesthesia. 

These  characteristics,  which  serve  to  make  the  diagno- 
sis, also  enable  us  better  to  understand  the  nature  of  the 
phenomenon.  In  fact,  the  tic  and  the  choreic  movement 
are  much  more  intellectual  phenomena  than  they 
appear  to  be.  We  notice  many  mental  phenomena 
at  their  beginning  exactly  as  at  the  beginning  of  som- 
nambulisms. One  has  had  an  accident  to  his  face  or 
eye,  another  a  pain  in  his  teeth ;  the  man  who  constantly 
blew  through  one  of  his  nostrils  had  had  for  a  long  time 
a  scab  in  his  nose,  consequent  upon  a  bleeding  at  the 
nose.  All  the  patients  who  have  had  mental  stiff  necks 
had  had  some  moral  impression  relating  to  a  movement 
of  the  head.  A  girl  I  am  attending  now  felt  very  dull 
at  home;  she  worked  all  day  long  by  a  window  that 
looked  out  into  the  street.  Her  strongest  desire  was  to 
leave  her  monotonous  work  and  go  out  into  the  street 
at  which  she  constantly  looked.  At  every  moment 
she  lifted  her  eyes  from  her  work  and  turned  her  head 
to  the  left  in  order  to  see  what  was  going  on  in  the 


Motor  Agitations  —  Contractures        127 

street.  She  gradually  felt  that  her  head  constantly 
turned  to  the  left,  and  even  maintained  that  her  hat 
was  too  heavy  on  that  side.  An  absurd  diagnosis,  the 
application  of  a  plaster  bandage,  had  singularly  ag- 
gravated her  state,  and  now  she  has  a  bad  mental  stiff 
neck  on  her  right  side. 

These  ideas,  these  more  or  less  definite  mental  phe- 
nomena which  existed  at  the  beginning,  persist  through- 
out the  development  of  the  tic  or  the  chorea.  Let  us 
return  to  a  singular  story,  which  I  have  often  related. 
It  tells  how  the  rhythmic  chorea  of  that  girl  of  sixteen 
had  begun,  who  kept  on  turning  her  right  wrist  and 
regularly  raising  and  lowering  her  right  foot.  One 
evening,  on  the  eve  of  the  quarter-day,  she  had  heard 
her  parents,  who  were  poor  work-people,  bewailing 
their  poverty  and  the  difficulty  they  had  in  paying  their 
landlord.  She  was  very  much  moved,  and  from  that 
time  she  had  at  night  a  kind  of  somnambulism,  during 
which  she  tumbled  and  tossed  in  her  bed  and  repeated 
aloud:  "I  must  work,  I  must  work."  Now,  what 
was  the  work  of  this  girl?  She  had  a  singular  trade, 
which  was  to  make  dolls'  eyes,  and,  for  this  purpose, 
she  worked  a  lathe  by  treading  a  pedal  with  her  foot 
and  turning  a  fly-wheel  with  her  right  hand.  During 
her  nocturnal  somnambulism,  she  made  this  movement 
of  the  hand  and  of  the  foot,  but  this  movement  was 
evidently  accompanied  with  a  corresponding  state  of 
consciousness,  since  she  repeated  aloud:  "I  must 
work."  It  was  a  simple  somnambulic  action,  like  all 
those  we  have  studied.  On  awaking,  she  no  longer  has 
any  recollection  or  consciousness  of  her  dream,  but  the 


128      The   Major  Symptoms  of  Hysteria 

movement  continues  exactly  the  same  on  her  right  side. 
Is  it  not  likely  that  it  is  still  accompanied  with  a  state 
of  consciousness  of  the  same  kind  ? 

We  can  make  this  state  of  consciousness  evident  by 
certain  experiments  which  we  know  now  how  to  effect. 
By  hypnotizing  the  subjects,  you  find  again  dreams 
that  account  very  well  for  the  continuation  of  the  tic. 
For  instance,  a  young  woman  comes  to  complain  of 
a  pretended  vertigo ;  it  appears  that,  in  the  street,  every 
hundred  steps,  she  feels  herself  as  it  were  precipitated 
forward,  that  she  suddenly  takes  a  leap  and  has  often 
fallen  while  taking  it.  What  a  strange  vertigo !  In 
a  state  of  induced  somnambulism  she  relates  to  us  what 
follows:  Once  she  went  to  her  parents,  who  sharply 
reproached  her  for  her  irregular  conduct.  On  going 
out  of  their  house,  she  took  a  resolution  that  simplifies 
many  things,  —  she  made  up  her  mind  to  commit 
suicide,  and  in  a  dream,  of  course,  for  she  was, 
happily  for  her,  hysteric  to  a  high  degree  —  she  fancied 
she  had  got  upon  the  parapet  on  the  bank  of  the  Seine, 
took  a  leap,  and  was  awakened  by  a  fall  to  the  ground. 
In  all  such  cases,  the  existence  of  a  system  of  images 
that  works  unknown  to  the  subject  is  undeniable. 

The  difficulty  is  greater  in  the  case  of  great  uncoor- 
dinated choreas,  in  which  all  the  motor  functions  seem 
to  take  a  part.  It  is  no  longer  merely  a  special  thought, 
a  system  of  images  that  seems  to  develop  outside  of 
consciousness,  it  is  a  function  in  its  entirety,  the  func- 
tion of  moving  the  arm  or  leg,  that  seems  to  emancipate 
itself.  Let  us  notice  for  the  present  this  phenomenon, 
which  appears  to  us  for  the  first  time;  it  will  become 
clearer  and  clearer  through  new  studies. 


Motor  Agitations  —  Contractures        129 


m 

Indeed,  the  problem  raised  by  such  dissociated  motor 
activities  working  separately,  outside  of  consciousness, 
becomes  singularly  complicated  when  we  examine 
other  forms  they  may  assume,  which  are  among  the 
most  important  phenomena  of  hysteria.  I  refer  to 
tremors  and  contractures. 

In  a  very  great  number  of  cases,  hystericals  have 
other  disturbances  of  motility  than  tics  and  choreas. 
Their  limbs  are  affected  with  a  strange  agitation  differ- 
ing from  the  preceding  ones;  for  example,  they  are 
seized  with  tremors ;  the  arm  has  regular  little  oscilla- 
tions, of  an  average  rate  of  five  to  nine  a  second.  These 
oscillations  are  nearly  continual.  There  are  some 
subjects  with  whom  they  never  stop,  either  when  they 
rest  or  when  they  move;  there  are  some  others  with 
whom  these  tremors  are  intermittent,  disappearing  at 
the  time  of  voluntary  activity  and  increasing  at  the 
time  of  diversion  and  rest.  But  it  is  not  possible  to 
establish  any  rule,  for  you  often  observe  the  reverse 
in  the  form  of  intentional  trembling,  analogous  to  that 
of  disseminated  sclerosis;  the  subject,  almost  motion- 
less when  at  rest,  begins  to  tremble  when  he  seeks  to 
perform  a  movement  (Figure  7). 

These  tremors  occur  under  various  conditions, 
sometimes  gradually,  after  paralytic  phenomena,  very 
often  suddenly,  after  an  emotion.  One  of  the  finest 
cases  I  have  observed  is  that  of  a  workman,  who,  in 
consequence  of  the  breaking  of  a  scaffolding,  remained 


Motor  Agitations  —  Contractures        131 

suspended  at  the  height  of  a  sixth  floor.  Others 
began  to  tremble  after  a  fright,  after  receiving  bad 
news.  In  one  of  my  observations,  the  tremor  which 
began  in  the  right  arm  was  consequent  on  a  dream. 
The  subject  fancied  he  was  pushing  back  an  assassin 
with  his  right  arm. 

In  some  rare  cases,  you  can  find  behind  the  tremors, 
as  behind  the  tics,  the  existence  of  a  fixed  idea  separated 
from  consciousness.  A  woman  who  presented  an  in- 
tense tremor  of  the  right  hand  at  last  confessed  that  this 
tremor  had  appeared  in  consequence  of  her  having 
long  practised  automatic  writing  in  order  to  question 
spirits.  It  was  enough  to  put  a  pencil  in  her  right  hand 
for  the  tremor  to  cease  and  to  be  transformed  into 
writing.1  So  we  had  certainly  to  deal  with  a  kind  of 
tic,  with  an  incomplete  subconscious  action  which 
assumed  the  appearance  of  a  tremor. 

But,  in  most  cases,  there  is  nothing  behind  the  tremor 
but  a  vague  emotive  state  and  a  kind  of  transformation 
of  the  motor  function  of  the  limb. 

It  is  what  we  observe  in  a  higher  degree  in  the 
exceedingly  serious  phenomenon  of  hysteric  con- 
tractures.  You  know  that  the  history  of  this  phe- 
nomenon may  be  said  to  begin  with  the  lessons 
of  Brodie,  1837,  "Lectures  Illustrative  of  Certain 
Local  Nervous  Affections";  then  we  have  the  works 
of  Coulson,  1851,  of  Paget,  1877,  of  Charcot,  of  Lasegue, 
of  Paul  Richer.  This  history  corresponds  to  the  evo- 
lution of  the  greatest  problems  of  medicine,  for  physi- 
cians have  been  led  gradually  to  separate  the  hysteric 

1  See  "  Ne"vroses  et  Id6es  fixes,"  II,  Observation  95,  p.  332. 


132      The  Major  Symptoms  of  Hysteria 

contractures  from  all  the  osseous,  articular,  medullary, 
and  nervous  affections  with  which  they  were  formerly 
confounded.  It  amounts  to  saying  that  this  problem 
is  connected  with  everything  in  medicine. 

This  contracture  is  a  state  of  moderate  contraction  of 
an  ensemble  of  muscles  which  maintains  a  limb  in  a 
determinate  position,  and  that  in  an  involuntary,  un- 
conscious, and  indefinite  manner.  Such  contractures 
can  be  observed  on  absolutely  all  the  muscles  of  the 
body,  and  in  each  region ;  they  raise  medical  problems 
which  I  can  only  point  out  to  you.  In  the  eyes,  they 
determine  the  spasm  of  the  orbicularis  and  the  occlu- 
sion of  the  eyelids ;  at  the  mouth,  they  are  located  very 
often  on  only  one  side,  and  they  bring  on  the  distortion 
of  the  face.  In  both  cases,  they  must  be  carefully  dis- 
tinguished from  paralytic  phenomena,  which  they  simu- 
late ;  from  the  ptosis  of  the  eyelids,  which  fall  passively 
instead  of  contracting;  and  from  the  paralysis  of  one 
side  of  the  face,  which  equally  causes  the  face  to  deviate 
to  the  opposite  side.  You  know  the  importance  of  the 
ptosis  of  the  eyelids  and  of  the  unilateral  paralysis  of 
the  face;  the  diagnosis  is  of  capital  importance.  The 
contracture  may  be  seated  in  the  neck,  back,  abdomen, 
or  thorax,  and  in  each  place  new  problems  arise.  Here 
it  simulates  diseases  of  the  vertebrae,  deviations  of  the 
vertebral  column;  here  it  transforms  the  breathing 
and  causes  you  to  believe  there  is  a  pulmonary  disease. 
In  other  cases  it  assumes  the  appearance  of  all  possible 
tumours  of  the  abdomen.  It  is  these  contractures  which 
originate  the  great  medical  errors  of  which  hysteria  is 
the  occasion.  As  regards  the  limbs,  we  have  the  con- 


Motor   Agitations  —  Contractures        133 

tractures  of  the  legs,  of  the  hip,  with  the  important 
problem  of  the  white  tumour  of  the  knee  and  of  tubercu- 
lous coxalgy.  I  think  the  most  expert  physician  ought 
never  to  boast  that  he  will  make  no  mistake  when  he 
has  to  decide  between  hysteric  coxalgy  and  tuberculous 
coxalgy.  As  regards  the  arms,  the  difficulty  is  not  so 
serious  in  general ;  yet  you  must  beware  of  false  luxa- 
tions of  the  shoulder,  of  arthrites,  and  of  cysts  of  the 
elbow  or  wrist.  There  is  not  a  more  important  clinical 
problem  than  that  of  contractures. 

Curiously  enough,  we  also  meet  here  with  an  im- 
portant psychological  problem,  with  a  question  that  is 
certainly  one  of  the  most  obscure  of  pathological  psy- 
chology. It  is  obvious  that  a  certain  number  of  the 
phenomena  connected  with  these  contractures  are  very 
clear;  first  we  know  that  contractures  are  consequent, 
like  all  hysteric  phenomena,  on  thoughts  and  emotional 
phenomena.  A  shock  has  no  action  in  this  direction 
except  when  it  determines  great  phenomena  of  imagina- 
tion. I  will  explain  myself :  An  individual  has  his  legs 
in  a  state  of  contracture  because,  he  says,  a  carriage 
ran  over  them.  After  verification,  it  is  found  that  the 
carriage  passed  beside  him,  and  that  he  felt  nothing  at 
all.  A  real  shock  would  do  less  than  this  imaginary 
shock. 

According  to  all  the  observations  that  have  been 
made,  the  production  of  a  contracture  requires,  exactly 
as  does  that  of  a  somnambulism,  some  emotion,  some 
fear  for  the  future,  some  terror,  some  dream,  etc.  It 
is  the  same  with  the  cure  of  these  contractures ;  in  cer- 
tain cases  they  persist  indefinitely.  I  have  two  cases 


134      The  Major  Symptoms  of  Hysteria 

which  lasted  for  thirty  years.  In  other  cases,  they  are 
suddenly  cured  through  influences  that  are  incompre- 
hensible if  one  does  not  take  into  account  imagination 
and  emotion.  These  diseases  are  among  those  which 
make  the  fortune  of  religious  relics  and  miraculous 
springs.  When  you  hear  a  story  about  a  cripple  with 
hard  shrivelled  legs,  twisted  under  his  body,  who  was 
rolled  to  the  spring  in  a  low  carriage,  and  got  up  again, 
bearing  away  his  carriage  on  his  shoulders,  you  need  not 
have  the  least  hesitation  in  pronouncing  the  case  one  of 
hysteric  contractures.  If  you  are  fond  of  erudition,  I 
recommend  you  to  read  the  admirable  book  of  Carr£ 
de  Montgeron  on  the  miracles  wrought  in  the  cemetery 
of  Saint  Medard  on  the  tomb  of  Deacon  Paris,  1737. 

It  is  also  phenomena  of  this  kind  that  physicians 
have  cured  in  determinate  conditions  by  all  sorts  of 
processes,  by  the  electric  current,  by  magnets,  by  the 
application  of  metallic  plates,  by  merely  speaking  to 
the  patients.  So  there  are  a  great  many  psychological 
phenomena  as  well  at  the  end  as  at  the  beginning  of 
contractures. 

You  also  meet  with  some  during  the  time  the  phe- 
nomenon itself  lasts.  First  of  all,  the  contracture  is 
more  frequently  systematic,  at  least  at  its  beginning, 
than  is  generally  believed.  The  limb  is  not  stiff  in 
every  position;  depending  on  the  unequal  strength  of 
the  different  muscles,  it  keeps  a  particular  attitude  re- 
quiring a  certain  harmony  of  permanent  contractions. 
A  woman  has  seen  in  the  hospital  an  individual  who 
had  died  of  tetanus;  she  reproduces  his  attitude,  and 
keeps  her  head  thrown  back.  Another,  of  whom  I  have 


Motor  Agitations  —  Contractures        135 

often  spoken,  constantly  keeps  both  her  feet  extended  in 
the  position  of  Christ  on  the  Cross ;  she  has,  moreover, 
a  religious  delirium  in  which  she  thinks  herself  crucified. 
She  has  crises  of  somnambulism  and  catalepsy  in  which 
her  trunk,  arms,  and  head  remain,  for  hours  together, 
absolutely  in  the  attitude  they  must  have  in  a  crucified 
person.1  During  these  crises  the  entire  attitude  decidedly 
corresponds  to  a  delirium  and  to  thoughts.  When,  in 
the  interval  of  the  crises,  the  feet  alone  keep  the  con- 
tracture,  it  is  very  likely  that  something  of  the  delirium 
persists. 

From  another  point  of  view  we  may  notice  that  the 
contracture  varies  with  certain  psychological  facts.  If 
the  subject  is  very  quiet,  if  nobody  touches  her  con- 
tractured  limb,  and  if  she  herself  does  not  try  to  make 
a  voluntary  movement,  we  may  see  that  the  contracture 
decreases  and  that  the  limb  unbends.  Lastly  we  may 
observe  in  contractures  many  forms  of  insensibility; 
the  subject  does  not  feel  the  fatigue  of  this  permanent 
contracture,  very  often  she  does  not  feel  anything  at  all 
in  her  contractured  limb.  In  a  word,  you  see  that  we 
may  notice  in  contractures  a  great  number  of  facts 
analogous  to  those  we  have  observed  in  tics  and 
choreas,  showing  us  a  kind  of  abnormal  functioning  of 
a  psychological  system  which  in  some  way  or  other  has 
become  independent. 

I  must  however  add  that  we  meet  here  with  a  new 
difficulty,  the  germ  of  which,  indeed,  was  already  to  be 
found  in  choreas  and  tremors.  Let  us  try,  with  our 

1  "  Une  extatique,"  Bulletin  de  I'lnstitut  psychologique  interna- 
tional, 1901,  p.  209. 


136      The  Major  Symptoms  of  Hysteria 

sound  limbs,  to  copy  the  attitude  of  a  rhythmic  chorea 
and  register  our  movements  accurately.  You  will  find 
that  you  are  much  more  awkward  than  a  hysteric  per- 
son, and  that,  unless  you  have  practised  specially  to 
this  end,  you  cannot  obtain  the  same  regularity.  Try 
to  keep  your  arm  in  the  position  of  a  hysteric  contrac- 
ture  and  describe  the  movement  of  the  arm;  you  will 
remark  that  you  have  not  the  same  perseverance  or 
courage  as  the  patient.  After  a  short  time,  your  arm 
trembles  and  is  displaced,  while  the  hysteric  contrac- 
ture  has  not  changed.  If  therefore  we  suppose  there  is 
a  psychic  action  in  these  hysteric  phenomena,  it  must 
be  acknowledged  that  this  action  is  not  identical  with 
ours,  but  that  it  is  performed  in  other  conditions. 

Here  is  my  hypothesis ;  think  of  it  what  you  please ; 
the  actions  that  are  manifested  by  muscular  movements 
present  different  degrees  of  perfection  corresponding  to 
the  development  and  systematization  of  the  conscious- 
ness that  accompanies  them.  These  degrees  of  per- 
fection are  manifested  first  of  all  by  psychological  char- 
acteristics of  the  action,  delicacy,  harmony,  usefulness 
of  the  act,  but  it  is  also  manifested  by  properties  of  the 
movements  themselves.  The  muscular  movement  of  a 
draughtsman's  hand  is  not  the  same  as  the  muscular 
movement  of  a  dog's  or  a  crocodile's  paw.  There  are 
some  particular  physiological  properties  accompanying 
the  perfection  of  the  act.  Some  are  known:  the 
rapidity  of  the  contraction  is  much  greater,  and  in 
particular  the  rapidity  of  the  decontraction,  of  the  fall 
of  the  muscle,  is  much  more  considerable.  In  the 
muscles  of  the  lower  animals,  the  contraction  takes 


Motor  Agitations  —  Contractures        137 

place  slowly  and  disappears  slowly.  We  see  also  the 
same  modifications  of  the  muscular  contraction  brought 
about  by  fatigue.  By  repetition,  muscular  contraction 
changes,  becomes  slower,  has  a  long  period  of  de- 
contraction  as  in  the  case  of  lower  animals.  I  even 
think  —  excuse  the  temerity  of  these  suppositions  — 
that  there  must  be  in  these  different  muscles  and  in 
these  different  states  of  activity  of  the  muscle  some 
anatomical  differences.  Great  stress  has  been  laid 
recently  on  the  two  organs  that  exist  in  the  muscular 
fibre :  the  fibrils  which  give  short  contractions,  and  the 
sarcoplasm  which  gives  long  and  permanent  contrac- 
tions. The  latter  predominates  in  the  smooth  fibres  of 
the  viscera,  the  former  in  the  striated  muscles  of  the 
voluntary  movements.  I  suppose  that  it  will  be  possi- 
ble later  on  to  observe  some  modifications  in  the  pro- 
portion of  these  two  substances  in  the  muscles  of  dif- 
ferent animals  according  to  their  state  of  evolution,  and 
in  the  different  states  of  the  same  muscles  in  rest  or  in 
fatigue,  for  instance. 

Now  action,  by  becoming  unconscious  in  hysterics, 
by  separating  from  consciousness,  loses  something  of 
its  dignity,  retrogrades  in  a  manner  and  assumes  an  ap- 
pearance that  recalls  the  action  of  the  visceral  muscles, 
the  action  of  the  lower  animals,  and  the  movements  of 
the  fatigued  muscles,  as  if  the  activity  of  the  sarcoplasm 
prevailed  over  that  of  the  fibrils.  This  is  what,  in  my 
opinion,  gives  to  the  subconscious  actions  of  the  hysteric 
those  abnormal  characteristics  we  saw  in  tremors  and 
contractures.  It  is  this  general  idea  that  prepares  us  for 
the  examination  of  the  phenomenon  of  hysteric  paralyses. 


LECTURE  VII 
PARALYSES  —  DIAGNOSIS 

The  clinical  study  of  hysteric  paralyses  —  The  beginning  of 
these  paralyses — Traumatic  neuroses — The  most  fre- 
quent types  of  paralysis —  The  diagnosis  of  hysterical 
paralyses —  The  intrinsic  characters —  The  localization 
and  form  of  the  paralysis —  The  examination  of  the 
reflexes  —  The  value  of  the  different  signs '—  The 
extrinsic  characters  — •  The  modification  of  sensibility 
—  The  description  of  hysteric  anesthesia 

FASHIONS  prevail  in  medical  studies  as  in  costumes. 
At  one  time,  one  problem  raises  general  enthusiasm,  and 
everybody  gives  it  his  exclusive  attention,  forgetting  all 
the  others.  Twenty  years  ago,  it  was  hysteric  som- 
nambulism that  was  in  fashion;  nowadays,  one  seems 
very  much  behind  the  age  when  one  speaks  of  som- 
nambulism. The  latest  fashion  is  to  apply  one's  self 
only  to  the  study  of  hysteric  paralysis.  Let  us  follow 
the  fashion  and  reflect  for  a  time  on  this  curious  problem 
of  physiology  and  psychology.  This  lecture  will  be  de- 
voted to  the  study  of  hysterical  paralysis  from  the 
clinical  point  of  view.  The  next  lecture  will  analyze 
the  psychological  features  of  paralysis  and  anesthesias. 

The  hysteric  are  capable  of  completely  paralyzing  a 
part  of  their  body.  You  know  what  I  mean  by  such 
an  expression.  I  need  only  state  that  patients  who 
have  had  the  accidents  we  spoke  of  before,  fits  of  all 

138 


Paralyses  —  Diagnosis  139 

kinds,  simple  or  complicated  somnambulism,  choreas 
of  a  special  kind,  mysterious  contractures  like  those  we 
have  seen,  may  besides  have  paralytic  accidents.  It 
does  not  mean  that  a  paralysis  that  presents  itself  in  a 
woman  who  has  had  fits  and  somnambulism  is  neces- 
sarily a  hysteric  paralysis,  obeying  the  psychological 
laws  of  this  kind  of  disease.  It  even  seems  to  be  the 
clearest  result  of  the  present  studies,  which  have  spread 
everywhere  nowadays,  to  show  us  that  it  is  not  always 
so;  that  often,  very  often  even,  the  paralysis  that  ap- 
pears is  a  commonplace  paralysis,  corresponding  to  a 
cerebral  or  medullary  lesion.  The  diagnosis  to  be 
made  is  exceedingly  difficult  and  important,  but  it  is 
nevertheless  true  that,  in  a  certain  number  of  cases, 
these  subjects  have  paralyses  analogous  to  their  other 
accidents,  whose  evolution  is  the  same  and  whose  diag- 
nosis and  nature  we  must  study. 


These  paralyses  appear  in  about  the  same  circum- 
stances as  the  other  phenomena ;  they  are  always  brought 
about  by  an  accident  which,  while  very  slight  in  itself, 
is  accompanied  by  a  violent  moral  emotion  and  by  dis- 
turbances of  the  imagination.  One  of  the  oldest  cases, 
and  a  very  interesting  one  from  a  historical  point  of 
view,  is  quite  typical.  I  allude  to  the  observation  of 
Estelle,  which  originated  the  remarkable  book  of  an 
old  magnetizer,  M.  Despine  d'Aix,1  in  1840:  A  girl 

1  Dr.  Despine  pere  (d'Aix).  De  I'emploi  du  magnttisme  animal 
dans  le  traitement  des  maladies  nerveuses,  suivi  d'une  observation  trls 
curieuse  de  guerison  de  n&vropathie.  1860. 


140      The  Major  Symptoms  of  Hysteria 

twelve  years  old  had  fallen  into  a  passion,  and,  against 
her  mother's  will,  had  quarrelled  and  fought  with  one 
of  her  little  friends.  In  the  heat  of  the  fight,  she  had 
been  knocked  to  the  ground,  and  had  fallen  rather 
violently  on  her  posterior.  This  fall  had  been  com- 
plicated by  an  aggravating  circumstance ;  namely,  her 
frock  had  been  much  dirtied  in  a  particularly  significant 
part.  The  pain  was  slight  and  did  not  prevent  the  girl 
from  getting  up  again  and  returning  home;  but  what 
is  essential  is  that  she  experienced  a  feeling  of  shame, 
of  fright,  and  tried  to -hide  her  fault.  The  next  day 
began  a  complete  paralysis  of  both  legs,  a  serious 
paraplegy  which  lasted  eight  years.  Bear  this  in  mind — 
eight  years'  paralysis  of  the  lower  limbs  for  having  fallen 
lightly  on  her  backside. 

Such  facts  were  hardly  known  at  that  time  to  any 
but  to  those  strange  magnetizers.  The  same  authors 
of  whom  we  spoke  lately,  Brodie,  Todd,  Duchenne  (de 
Boulogne),  Russell  Reynolds,  Charcot,  Oppenheim,  and 
all  the  modern  authors,  were  the  ones  who  began  to 
study  what  was  first  called  traumatic  neuroses.  Indeed, 
traumatic  accidents  are  among  the  most  frequent  causes. 
Railway  catastrophes  give  rise  to  many  of  these  acci- 
dents, and  some  physicians  had  even  adopted  the  ex- 
pression of  railway  spine.  Falls  from  carriages,  from 
horseback,  and  shocks  received  in  battles  are  their  most 
common  origin. 

For  instance,  a  drunken  carter  falls  from  his  box  on 
his  right  arm  and  presents  a  paralysis  of  this  arm.  A 
man  of  eighteen  falls  in  a  staircase  on  his  back ;  the  con- 
sequence is  a  paralysis  of  the  legs  and  a  contracture  of 


Paralyses  —  Diagnosis  141 

the  lumbar  muscles.  Often  the  shock  is  only  imaginary ; 
the  celebrated  patient  who  appears  in  the  first  lessons 
of  Charcot  thinks  he  has  been  wounded  by  a  carriage 
which  did  not  run  over  him.  One  of  the  last  observa- 
tions I  have  noted  is  very  strange:  A  man  travelling 
by  rail  had  done  an  imprudent  thing:  while  the  train 
was  running,  he  had  got  down  on  the  step  in  order  to 
pass  from  one  door  to  the  other,  when  he  became  aware 
that  the  train  was  about  to  enter  a  tunnel.  It  occurred 
to  him  that  his  left  side,  which  projected,  was  going  to 
be  knocked  slantwise  and  crushed  against  the  arch  of 
the  tunnel.  This  thought  caused  him  to  swoon  away, 
but,  happily  for  him,  he  did  not  fall  on  the  track,  but 
was  taken  back  inside  the  carriage,  and  his  left  side 
was  not  even  grazed.  In  spite  of  this,  he  had  a  left 
hemiplegy. 

Other  circumstances  may  act  similarly,  as,  for  in- 
stance, fatigues,  especially  when  located  in  a  limb.  A 
house-painter  felt  his  hand  very  tired  while  painting  a 
ceiling,  and  presented  a  severe  paralysis  of  his  right 
hand.  I  found  it  likewise  in  a  girl  who  was  learning 
the  violin,  in  those  who  had  tired  their  hands  on  the 
piano.  But  here  again,  to  the  fatigue  must  be  added 
an  emotional  state,  as  in  this  classical  observation  of 
Fere* ;  a  girl  who  tires  herself  in  learning  a  piece  on  the 
piano  is  seized  with  a  paralysis  of  her  right  hand  at  the 
moment  when  she  is  to  play  this  piece  at  a  ceremony. 
The  part  of  emotion  is  so  great  that  it  may  be  sufficient, 
when  added  to  a  purely  imaginary  fatigue,  as  in  this 
other  observation  of  Fe"re" :  a  girl  dreams  at  night  that 
she  is  pursued  by  a  man  and  that  she  runs  very  fast  in 


142      The  Major  Symptoms  of  Hysteria 

the  streets  of  Paris;  she  dreams  that  she  is  exhausted 
with  fatigue,  though  she  has  not  moved.  The  next  day 
she  is  none  the  less  paraplegic.  Lastly,  there  are  some 
paralyses  that  follow  somnambulisms  and  crises,  with- 
out our  knowing  very  well  for  what  reason,  but  as  we 
shall  see  later  on,  they  affect  limbs  formerly  paralyzed, 
or  having  in  them  causes  of  decay,  rachitic  deforma- 
tion, old  scars,  varices,  etc. 

The  paralyses  thus  brought  about  may  be  very 
various.  For  the  present,  I  only  point  out  to  you  those 
most  common  and  most  anciently  studied ;  I  reserve 
others  for  the  end  of  this  study,  because  they  are  par- 
ticularly interesting  as  regards  the  interpretation.  The 
most  common  hysteric  paralyses  seem  to  be  analogous 
to  the  great  organic  paralyses.  The  most  frequent,  the 
most  carefully  studied,  nowadays,  is  great  hemiplegy,  in 
which  one  half  of  the  body  is  completely  paralyzed. 
Usually,  it  is  true,  hysteric  paralysis  strikes  the  limbs 
rather  than  the  face,  but  the  rule  is  not  absolute ;  when 
the  paralysis  is  in  the  right  side,  for  instance,  the  face 
and  speech  may  be  paralyzed  as  well  as  the  arm  and 
leg.  Here  is  a  girl  of  nineteen,  already  neuropathic,  and 
daughter  of  an  epileptic  mother,  who  lost  her  father  a 
fortnight  ago.  The  poor  girl  supported  him  with  her 
right  arm  during  his  agony ;  on  the  very  evening  of  the 
day  on  which  he  died,  she  felt  exhausted  with  fatigue, 
especially  in  her  right  side,  and  her  right  leg  trembled 
when  she  tried  to  support  herself  on  it.  She  could  not 
sleep,  thinking  every  moment  she  saw  and  heard  her 
father.  The  next  morning,  she  had  a  pain  in  her 
abdomen,  the  menstrual  discharge  reappeared  out  of 


Paralyses  —  Diagnosis  143 

its  period,  the  weakness  in  the  right  side  had  increased. 
On  the  third  day  the  right  arm  and  leg  could  still  move, 
but  trembled  continually.  On  the  following  day  the 
right  hemiplegy  was  complete  and  speech  was  entirely 
lost.  After  a  fortnight  the  movements  were,  little  by 
little,  completely  restored.  I  will  observe  to  you  here 
that  this  hemiplegy  may  appear  in  a  more  dramatic 
manner,  after  a  convulsive  fit  or  a  profound  sleep,  which 
then  absolutely  simulates  the  apoplectic  stroke.  In 
such  cases,  the  diagnosis  is  very  delicate;  though  the 
hypothesis  of  a  hemiplegy  and  a  hysteric  sleep  is  diffi- 
cult and  rare,  you  must  however  think  of  it.  Not  long 
ago,  I  recognized  an  accident  of  this  kind  in  a  man 
sixty  years  old,  who,  at  first  sight,  looked  quite  as  if  he 
had  had  an  apoplexy. 

The  second  severe  and  frequent  form  is  paraplegy, 
in  which  both  legs  are  completely  paralyzed.  This 
accident  often  appears  when  an  individual  is  seized 
with  an  emotion  while  walking.  It  is  about  what 
English  physicians  call  the  "giving  way  of  the  legs." 
A  young  woman  of  twenty-five  (what  is  strange  is  that 
she  was  a  nurse,  who,  as  such,  ought  to  have  known 
better)  was  one  evening  crossing  a  dormitory ;  she  saw 
a  patient  in  a  crisis  of  somnambulism  getting  up  and 
going  about  wrapped  up  in  a  sheet.  She  took  her  for  a 
phantom,  was  terribly  frightened,  felt  her  legs  shake 
under  her  and  fell  down  without  being  able  to  get  up 
again.  She  remained  paraplegic  for  several  months. 
You  must  also  beware  of  these  paraplegics  after  child- 
births,  and  after  somewhat  long  diseases  in  which  the 
subjects  have  remained  long  in  bed. 


144      The  Major  Symptoms  of  Hysteria 

The  third  form  will  be  monoplegy,  which  strikes  a 
limb  or  a  segment  of  a  limb,  for  these  paralyses  may  be 
very  limited.  With  the  painter  I  spoke  of,  it  affected 
only  the  right  wrist ;  in  other  cases  it  affects  the  articu- 
lation of  the  elbow,  or  the  shoulder,  the  foot,  or  the 
whole  of  the  leg.  A  long  discussion,  which  is  not  yet 
quite  settled,  bears  upon  the  existence  of  hysteric  facial 
paralyses.  Charcot  denied  them  and  maintained  that 
what  was  called  a  paralysis  of  the  right  side  of  the  face 
was  nothing  but  a  contracture  of  the  left  side.  He 
only  admitted  in  the  face  the  existence  of  the  glosso- 
labiate  spasm.  This  opinion  has  been  much  contra- 
dicted and  many  cases  of  facial  paralyses  have  been 
brought  forward  which  seem  tc^  be  typical.  For  my 
part,  I  do  not  see  why  paralysis  of  the  eyelids,  mouth, 
and  cheek  should  not  exist,  and  I  have  recognized  some 
cases  of  this  disease  which  seem  to  be  convincing. 

Lastly,  there  may  be  paralyses  of  the  trunk,  and  I 
refer  you  to  the  most  interesting,  in  my  opinion,  of  the 
studies  I  have  had  the  opportunity  of  making  on  this 
matter.  The  subject  is  a  girl  who  had  fallen  into  a 
well,  and  who,  after  this  accident,  presented  a  remark- 
able flaccidity  of  all  the  muscles  of  the  trunk.  She  was 
quite  unable  to  stand  or  sit,  her  head  and  body  fell  in- 
differently on  every  side.  At  the  same  time  she  had  a 
remarkable  paralysis  of  the  diaphragm,  on  which  we 
cannot  insist  for  the  present.1  Such  are  the  chief  forms 
presented  by  hysteric  paralyses.  I  must  now  some- 
what insist  on  their  diagnosis,  which  is  of  capital  im- 
portance for  you. 

1  N£vroses  et  Idees  fixes,  I,  p.  328,  II,  p.  411. 


Paralyses  —  Diagnosis  145 


n 

The  diagnosis  of  hysteric  paralyses  can  be  made  in 
two  manners.  First,  in  an  extrinsic  manner,  which  was 
formerly  considered  as  the  more  important.  In  this  case 
you  examine  the  symptoms  that  are  foreign  to  the  pa- 
ralysis itself,  the  disturbances  of  the  sensibility,  the  dis- 
turbances of  the  intelligence,  the  simultaneous  phenom- 
ena, the  circumstances  of  the  appearance,  etc.  Secondly, 
you  can  make  this  diagnosis  by  an  intrinsic  examina- 
tion, which  chiefly  takes  into  account  the  paralysis  itself 
and  its  clinical  characteristics.  This  second  method  ap- 
pears nowadays  to  be  more  accurate  and  scientific  and 
is  often  preferred.  As  I  told  you,  the  fashion  nowadays 
requires  that  you  should  discover  the  curious  little 
modifications  of  the  reflexes  which  may  characterize  a 
paralysis  without  having  to  make  any  inquiry  of  the 
patient  or  those  around  him. 

Let  us  then  first  give  our  attention  to  those  intrinsic 
characters,  since,  at  the  present  time,  they  are  con- 
sidered as  more  serious.  You  may  first,  in  certain 
cases,  take  into  account  the  localization  and  form  of 
the  paralyses.  An  Austrian  author,  Professor  Freud, 
has  insisted  a  great  deal  on  this  point.  Hysteric 
paralysis  never  affects  only  one  muscle,  it  is  always  a 
paralysis  in  a  mass,  which  strikes  a  group  of  muscles. 
Do  not  suppose  that  every  group  of  muscles  may  be 
thus  affected.  The  group  that  is  affected  is  always 
one  that  is  necessary  to  a  function  of  a  part  of  the  body. 
Yet  the  paralysis  does  not  extend  beyond  the  limit  of 


146      The  Major  Symptoms  of  Hysteria 

the  muscles  necessary  for  the  functioning  of  this  part 
of  the  body;  it  does  not  easily  encroach  upon  other 
regions.  It  is  otherwise  in  all  organic  paralyses;  a 
lesion  of  a  nerve  may  affect  only  certain  muscles;  a 
lesion  of  a  nervous  plexus  affects  several  muscular  groups. 
For  instance,  in  the  paralysis  of  the  leg  brought  about 
by  hysteria,  the  thigh  and  buttock  are  affected,  but  the 
sacral  region  and  the  genital  region  are  intact,  which  is 
not  the  case  in  spinal  paralyses.  The  same  author  re- 
marks further  that  hysteric  paralysis  is  often  seated  in 
the  extremities  of  the  limbs  only,  which  does  not 
happen  in  organic  paralyses,  the  latter  more  often 
affecting  segments  that  are  near  the  centre. 

Notice  also  that  hysteric  paralysis  is  exaggerated, 
always  carried  to  an  extreme,  which  is  very  rare  in 
organic  paralyses.  A  man  whose  hemiplegy  is  con- 
sequent on  a  cerebral  hemorrhagy  can  still  move  a 
little,  and  makes  some  efforts  to  conceal  his  paralysis; 
one  in  whom  hemiplegy  is  due  to  hysteria  has  no  longer 
a  shadow  of  a  movement  in  his  diseased  side.  Hence 
comes  this  difference  in  the  gait  which  Todd  and  Charcot 
formerly  pointed  out,  and  for  which  they  invented  rather 
barbarous  Greek  words.  The  subject  affected  with 
organic  hemiplegy,  they  said,  has  a  helicopode  walk ;  he 
walks  helically,  throwing  his  paralyzed  leg  sideways  by 
a  movement  of  his  loins.  The  subject  affected  with 
hysteric  hemiplegy  has  a  helcopode  walk;  he  drags  his 
paralyzed  leg  in  walking  as  if  he  did  not  trouble  him- 
self about  it  in  the  least,  as  if  it  no  longer  existed  at  all. 

To  these  positive  characteristics  are  added  negative 
characteristics;  hysteric  hemiplegy  is  not  accompanied 


Paralyses  —  Diagnosis  147 

by  any  other  serious  disturbances  in  the  diseased  limb; 
in  particular,  there  is  no  atrophy,  or  at  least  a  very 
long  time  is  required  for  it  to  appear  after  the  period 
of  immobility;  so  you  must  always  carefully  meas- 
ure the  two  limbs  of  the  patient.  The  existence  of  a 
notable  atrophy  will  help  you  to  recognize  certain  lesions 
of  the  medulla  or  brain.  Nor  are  there  any  disturbances 
of  the  electric  reactions;  the  reaction  called  reaction  of 
degeneration,  which  is  so  rapid  in  certain  forms  of 
medullar  lesions,  does  not  exist  in  hysteric  paralysis. 

We  come,  at  last,  to  the  question  of  the  reflexes,  now 
considered  as  very  important,  chiefly,  it  must  be  said,  on 
account  of  the  studies  of  a  French  physician,  M. 
Babinski,  who  has  devoted  himself  to  this  subject.  In 
a  general  way,  all  the  reflexes  of  a  limb  must  remain 
normal  in  a  hysteric  paralysis.  This  may  easily  be 
understood,  since  these  reflexes  depend  for  the  most 
part  on  lower  medullar  or  cerebral  centres  which  are 
supposed  not  to  be  affected  with  any  disturbance.  On 
the  contrary,  in  an  organic  lesion,  a  certain  number  of 
reflexes  must  always  be  injured,  because  the  lesion 
always  bears  more  or  less  upon  one  of  these  centres. 
You  have  first  to  consider  the  tendinous  reflexes  in  the 
elbow,  wrist,  knee,  tendon  of  Achilles.  They  must  not 
be  suppressed,  as  in  tabes,  nor  exaggerated  as  in  cerebral 
hemorrhagy  or  in  the  lesions  of  the  pyramidal  tract. 
You  will  seek,  especially  in  the  foot,  for  the  epileptoid 
trepidation.  The  clonus  determined  by  the  sudden 
raising  of  the  foot  which  appertains  exclusively  to  the 
lesions  of  this  pyramidal  tract,  does  not  exist  in  hysterical 
paralysis. 


14.8      The  Major  Symptoms  of  Hysteria 

You  will  also  examine  the  cutaneous  reflexes ;  for  in- 
stance, Babinski  has  shown  the  very  important  sign 
given  by  the  toes,  when  the  ball  of  the  foot  is  slightly 
rubbed  with  a  pin.  In  normal  adults  —  for  there  are 
some  irregularities  in  children  —  the  toes  bend  together 
towards  the  sole  of  the  foot.  In  the  lesions  of  the 
medulla,  on  the  contrary,  you'  observe  a  raising  and 
extension  of  the  toes,  but  nothing  like  this  can  be  ob- 
served in  hysteria.  Excitation  of  the  skin  in  different 
regions  of  the  body,  on  the  internal  face  of  the  thighs, 
on  the  abdomen,  on  the  neck,  determine  in  a  normal 
man  contractions  of  the  "peaucier"  muscles,  that  is  to 
say  the  muscles  of  the  skin,  which  disappear  in  organic 
accidents  and  not  at  all  in  neuropathic  phenomena. 
Don't  forget  to  examine  carefully  the  reflexes  of  the 
pupils  to  light,  to  accommodation;  the  slightest  dis- 
turbances of  these  reflexes  must  put  you  on  your  guard. 
You  know  that  the  least  alteration  of  these  reflexes 
strongly  inclines  you  to  admit  organic  lesions,  either 
those  of  tabes  or  those  of  syphilitic  meningitis. 

Lastly,  Babinski  has  shown  the  importance  of  the 
preservation  of  the  muscular  tonus  in  hysterical  paralyses. 
He  insisted  too  with  great  accuracy  on  the  preservation 
of  certain  unconscious  movements  produced  by  associa- 
tion in  these  apparently  paralyzed  limbs.  This  fact  is 
analogous  to  the  observation  of  the  preservation  of  cer- 
tain subconscious  sensations  in  spite  of  hysterical  anes- 
thesia, that  we  have  to  study  in  the  following  lecture. 

According  to  these  authors,  this  ensemble  of  signs  is 
absolutely  characteristic,  and  it  is  possible  to  recognize 
a  hysteric  hemiplegy  solely  through  this  objective  ex- 


Paralyses  —  Diagnosis  149 

amination  which  requires  nothing  of  the  patient's  psy- 
chological observation.  The  thing  is  perfect  theo- 
retically, but  practically  it  is  much  more  difficult  than 
is  supposed.  Most  of  the  signs  we  have  spoken  of, 
when  treating  of  the  localization  of  paralysis,  either  are 
indecisive  or  apply  but  to  quite  particular  cases. 

The  signs  of  the  reflexes  are  much  more  important, 
but  can  we  absolutely  trust  them  ?  First  of  all  we  must 
eliminate  the  signs  derived  from  the  mere  exaggeration 
of  the  tendinous  reflexes.  You  cannot  eliminate  hysteria 
merely  because  a  patient  throws  his  leg  upward  too 
strongly  after  the  shock  of  the  rotular  tendon,  for  this 
exaggeration  of  the  reflex  is  exceedingly  difficult  to  ap- 
preciate and  very  irregular.  A  very  great  number  of 
subjects,  when  a  little  moved  or  nervous,  throw  their 
legs  too  strongly  upward  when  their  knee  is  struck.  It 
may  be  said  that  one  should  distinguish  the  real  reflex, 
which  is  quick  and  simple,  from  the  semi-voluntary, 
semi-emotional  movement  which  is  added  to  it,  and 
which  is  too  tardy,  too  long,  too  much  generalized.  All 
this  is  true  enough,  but,  in  practice,  I  defy  you  to  make 
the  distinction,  and  moreover  I  am  inclined  to  believe 
that  in  hysteric  and  neurasthenic  patients  there  is  often 
a  real  exaggeration  of  the  reflexes,  which  is  perhaps 
due  to  a  diminution  of  cerebral  inhibition. 

The  sign  of  the  clonus  of  the  foot  has  more  importance. 
The  significance  is  much  discussed  at  the  present  time, 
and  several  authors  point  out  cases  of  unquestionably 
hysteric  paralyses  in  which  it  has  been  met  with.  Some 
authors  maintain  that  if  they  take  the  graphic  of  the 
shake  with  the  registering  apparatus,  they  recognize  the 


150      The  Major  Symptoms  of  Hysteria 

regularity  of  the  organic  clonus  in  contradistinction  to 
the  irregularity  of  the  hysteric  clonus.  But  this  is  not 
quite  certain. 

Babinski's  sign  of  the  toes  is  exceedingly  interesting. 
In  reality,  you  need  not  hesitate  when  it  manifests  itself 
clearly ;  I  don't  think  it  has  yet  been  distinctly  observed 
in  a  hysteric  paralysis.  But  it  is  an  irregular  sign,  which 
often  fails  totally.  Many  subjects  do  not  react  at  all 
or  react  by  a  retraction  in  a  mass  of  the  leg.  The 
pupillary  reflexes  are  likewise  of  capital  importance; 
be  always  on  your  guard  when  you  meet  with  the  sign 
of  Argyll  Robertson.  But  this  sign  is  not  absolutely 
characteristic  either;  first  of  all,  many  neuropathic 
patients  have  pupillary  dilatation,  then,  in  some 
hystericals,  there  are  contractures  of  the  iris  with  dila- 
tation or  myosis,  which  prevent  the  reflexes  from  taking 
place  easily  and  may  again  be  causes  of  error. 

In  a  word,  it  is  certain  that  the  intrinsic  examination 
gives  us  exceedingly  valuable  indications.  The  in- 
vasion of  the  face,  the  disturbances  of  speech,  the 
clonus,  the  signs  of  the  toes,  the  pupillary  disturbances 
are  strongly  in  favour  of  an  organic  lesion.  Unfor- 
tunately they  are  not  absolutely  certain  signs,  and  I 
think  one  is  quite  wrong  in  making  things  more  diffi- 
cult than  they  are,  in  refusing  the  unquestionable 
services  rendered  to  diagnosis  by  much  more  charac- 
teristic extrinsic  signs. 

Ill 

The  most  important  extrinsic  sign  of  all  is  derived 
from  the  examination  of  sensibility,  the  modifications 


Paralyses  —  Diagnosis  151 

of  which  are  of  the  greatest  importance  in  hysteria.  We 
already  met  with  them  when  studying  choreas  and 
contractures ;  we  observed  that  the  hysteric  patient  often 
appears  not  to  know  what  is  going  on  in  her  arm  or 
leg,  that  she  does  not  feel  the  fatigue  of  her  protracted 
shakes  or  contractions,  and  that,  what  is  more,  she 
may  not  feel  the  movement  of  which  her  arm  is  the  seat. 
This  anesthesia  is  still  more  characteristic  in  paralyses. 
We  must  therefore  insist  now  on  its  study. 

For  a  long  time  physicians  had  had  some  vague 
notions  about  the  odd  insensibilities  of  these  patients. 
You  know  that  in  the  Middle  Ages  people  recognized 
witches  and  possessed  persons  by  seeking  on  their 
bodies  for  what  was  called  the  claw  of  the  devil.  It 
was  a  more  or  less  extensive  part  of  the  skin  in  which 
the  subject  was  insensible  to  any  touch  or  prick.  The 
expert  entrusted  with  this  work  would  close  the  eyes  of 
the  subject,  and,  armed  with  a  sharp  needle,  prick  here 
and  there  the  different  parts  of  the  body.  The  sufferer 
was  to  answer  with  a  cry  to  each  prick,  and  the  claw 
of  the  devil  on  a  certain  spot  was  recognized  from  the 
fact  that  he  did  not  cry  when  this  spot  was  examined. 
Later  on,  Sydenham,  in  1681,  then  Louyer  Villermay 
in  1816,  Georget  in  1824,  Landouzy  in  1846,  later  still, 
Briquet,  Charcot,  and  all  the  modern  authors  have 
strongly  insisted  on  all  the  varieties  of  this  phenomenon. 

For  the  present  we  shall  attend  to  the  indications  that 
anesthesia  can  give  us  as  regards  the  diagnosis  of 
hysteric  paralyses,  and  especially  to  its  seat  and  depth. 
This  insensibility  must  be  sought  for  this  purpose  in 
three  organs,  on  the  skin,  on  the  mucous  membranes, 


152      The  Major  Symptoms  of  Hysteria 

and  in  the  muscles.  It  may  indeed  extend  either  over 
the  cutaneous  coat  of  the  limb,  or  over  the  accessible 
mucous  membranes  of  the  natural  orifices,  or  it  may 
bear  upon  the  sensations  of  motion  and  upon  the  notion 
of  the  position  of  the  limbs.  In  the  first  case,  we  have 
to  examine  the  skin  and  mucous  membranes  as  re- 
gards contact  by  passing  our  finger  or  a  blunt  instru- 
ment over  them.  We  may  hope  to  obtain  more  accu- 
rate results  by  the  use  of  the  aesthesiometer,  which  shows 
us  how  the  subject  recognizes  the  differences  of  sensa- 
tion depending  on  the  different  spots  of  the  skin.  You 
will  examine  on  these  same  regions  the  temperature- 
sensations  by  alternately  applying  on  the  skin,  unknown 
to  the  subject,  a  cold  and  a  warm  object;  lastly  you 
will  examine  the  sense  of  pain  by  pinching,  by  stick- 
ing in  a  needle,  or  by  using  one  of  the  various  algesi- 
meters.  You  will  thus  find  that  these  various  sensibili- 
ties may  completely  disappear,  either  simultaneously  or 
separately.  It  is  not  rare  to  find  absolute  insensibility 
of  the  skin  accompanying  hysteric  paralysis. 

You  will  then  examine  the  so-called  muscular  sen- 
sibility by  displacing  the  limb  in  different  ways  and 
asking  the  subject  to  describe  these  positions  and  move- 
ments without  looking  at  them,  or  better  still,  to  repro- 
duce them  with  his  uninjured  arm.  Here  again  you 
will  often  find  in  hysteric  paralyses  complete  insen- 
sibility to  position,  the  subject  no  longer  possessing  any 
information  about  his  diseased  limb. 

The  existence  of  such  anesthesias  already  gives  you 
an  important  piece  of  information.  No  doubt  anes- 
thesia exists  in  organic  lesions,  but  it  is  much  rarer 


Paralyses  —  Diagnosis 


'53 


and,  in  general,  not  nearly  so  deep  as  in  hysteric 
affections.  Further,  it  is  easy  to  acknowledge  that  the 
anesthesia  when  it  is  connected  with  hysteria  presents 
certain  characters  that  are  not  to  be  found  when  the 
insensibility  depends  on  organic  affections  of  the  ner- 
vous system. 

One  of  the  characteristics  of  this  anesthesia,  and  one 
that  plays  a  most  important  part  in  the  diagnosis,  has 
been  well  illustrated 
by  Charcot  and 
nowadays  still  ap- 
pears to  us  to  be 
very  significant :  the 
localization  or  the 
place  of  this  insen- 
sibility. Charcot 
used  to  say  that  in 
hysteric  paralyses 
anesthesia  takes  the 
form  of  geometric 
segments,  meaning 

that     it      is     termi-        FIG.  8.  —  Schema  of  hysteric  left  hemianes- 

nated   by   distinct,  thesia- 

regular  lines  assuming  definite  forms  which  can  be 
foreseen.  Of  course,  when  the  hemiplegy  is  complete 
and  the  hemianesthesia  is  also  complete,  the  form  is 
very  clear,  but  has  no  great  significance ;  it  stops  just 
at  the  median  line  of  the  body,  dividing  into  two  equal 
parts  the  forehead,  nose,  mouth,  breast,  and  abdomen 
(Figure  8).  This  section  is  curiously  regular ;  on  the  one 
side,  the  skin  is  absolutely  insensible,  as  well  as  the 


154      The  Major  Symptoms  of  Hysteria 

mucous  membranes  and,  as  we  shall  see  later  on,  the 
organs  of  the  senses.  On  the  other  side,  the  sensibility 
is  intact.  You  may  barely  observe  some  transition, 
some  degradation  on  the  median  line  of  the  body.  On 
one  side,  the  subject  feels  nothing;  on  the  other,  she 
feels  quite  normally.  It  is  true  even  of  the  mouth  and 
tongue ;  the  separating  line  is  found  on  the  palate  and 
tongue.  This  hemianesthesia  exists  also  in  certain 
forms  of  organic  lesions,  in  certain  lesions  of  the  in- 
ternal capsule ;  one  may  at  most  say  that  it  is  rare,  and 
that,  in  general,  the  separation  is  not  so  clear,  that 
there  is  a  broader  line  of  demarcation,  with  confused 
sensibility.  One  may  say,  too,  that  usually  the  troubles 
of  sensibility  are  more  severe  in  the  extremities  than  at 
the  root  of  the  limbs,  instead  of  being  regularly  the 
same  in  all  the  parts  as  in  hysteria.  But,  of  course,  in 
this  case  the  form  of  the  anesthesia  will  not  give  you 
much  information. 

In  the  other  paralyses,  the  form  of  the  anesthesia  is 
more  instructive ;  it  seems  to  terminate  precisely  enough, 
above  the  paralyzed  organ  by  a  nearly  circular  line 
traced  by  the  plane  perpendicular  to  the  axis  of  the 
limb.  Thus  a  paralysis  of  the  hand  brings  about  an 
anesthesia  of  the  hand  extending  up  to  the  wrist  and 
terminated  by  a  line  in  the  form  of  a  bracelet  (Figure  9) ; 
an  anesthesia  of  the  whole  of  the  arm  is  limited  by  a 
line  including  the  shoulder,  passing  a  little  under  the 
arm-pit,  in  the  form  of  a  jacket-sleeve,  as  Charcot  used 
to  say.  A  paralysis  of  the  foot  brings  about  a  sock  or  a 
stocking  of  anesthesia.  A  paralysis  of  the  leg  gives 
birth  to  an  anesthesia  in  the  form  of  a  leg  of  mutton, 


Paralyses  —  Diagnosis 


'55 


which    generally    spares    the    anus    and    the    genitals 
(Figure  9). 

Now  these  forms  of  anesthesia,  which  look  so  simple, 
are  particularly  extraordinary  from  a  physiological 
point  of  view.  They 
by  no  means  cor- 
respond to  the  dis- 
tribution of  the 
nerves  or  even  of 
the  nervous  plex- 
uses. You  know 
that  the  hand  is  in- 
nervated by  three 
principal  nerves, 
the  radial,  the  me- 
dian, and  the  cubi- 
tal. A  section  of 
one  of  these  nerves 
brings  about  a  well- 
known  anesthesia  of  anatomic  form  corresponding  to 
the  distribution  of  the  nerve.  You  know,  for  instance, 
the  old  anesthesia  of  the  lesions  of  the  cubital,  which 
only  affects  the  little  finger  and  the  longitudinal  half  of 
the  fourth  (Figure  10) :  it  is  not  at  all  like  our  geometric 
segments  in  the  case  of  a  paralysis  of  the  hand.  A 
lesion  of  the  brachial  plexus  anesthetizes  only  a  part 
of  the  arm,  and  the  limit  of  the  anesthesia  affects  a 
special  form,  because  it  reserves  the  sensibility  of  a 
portion  of  the  shoulder  above  the  deltoid,  which  is  in- 
nervated by  the  cervical  plexus  (Figure  1 1).  A  lesion  of 
the  sacral  plexus  brings  about,  it  is  true,  the  anesthesia 


FIG.  9.  —  Schema  of  various  forms  of  local- 
ized hysteric  anesthesia. 


156      The  Major  Symptoms  of  Hysteria 

of  the  thighs  on  their  internal  face,  but  affects  the  anus 
and  the  genitals.  On  this  distribution  of  the  insensi- 
bilities and  on  the  places  of  the  reserved  regions  is 
founded  the  anatomic  diagnosis  of  the  lesions  of  the 
nerves  and  of  the  tumours  of  the  medulla.  But  it  is 


Mcdtin 


FIG.  10.  —  Cutaneous  territories  of  the  peripheric  nerves  in  the  right  arm. 
A,  anterior  face;  P,  posterior  face.  (See  Dejerine,  "  S6miologie  du  Sys- 
teme  nerveux,"  in  "  Traite  de  Pathologic  Generate,"  V,  p.  952.) 

not  possible  to  connect  the  forms  of  anesthesias  we  just 
observed  in  the  hysteric  paralyses  with  these  forms  given 
by  the  organic  lesions. 

This  difficulty  of  localization  was  so  great  that  Briquet 
tried  to  make  other  hypotheses  and  asked  himself 
whether  the  distribution  of  hysteric  anesthesias  did  not 
depend  on  the  vascular  circumscriptions,  on  the  cir- 

l 


Paralyses  —  Diagnosis  157 

culation  of  the  blood,  more  than  on  the  nervous  cir- 
cumscriptions. Now  we  see  that  such  is  not  the  case, 
there  is  no  arterial  irrigation  in  the  form  of  a  wrist  band, 
a  jacket  sleeve,  or  a  leg  of  mutton.  This  form  of  an- 
esthesia is  something  quite  peculiar. 

I  have  tried  formerly  to  sum  up  these  localizations 
of  hysteric  anesthesia  by  a  word  that  has  had  success ; 
the  hysteric  patient,  I  said,  seems  to  attend  to  the  popu- 


FlG.  ii.  —  Localization  of  the  anesthesia  in  a  case  of  a  lesion  of  the 
brachial  plexus.    Id.,  ibid.,  p.  951. 

lar  conception  of  the  organ  rather  than  to  its  anatomic 
conception.  For  the  common  people,  what  is  an  eye? 
It  is  the  ensemble  of  the  organs  that  fill  the  orbit,  eye- 
lids included,  and,  in  fact,  the  hysteric  person  who  has 
anesthesia  of  the  eyes  has  on  her  face,  as  it  were,  a  pair 
of  spectacles  of  anesthesia  (Figure  9)  affecting  the  two 
eyelids  in  their  central  part.  For  the  common  people, 
the  hand  terminates  at  the  wrist.  They  don't  care  if  all 
the  principal  muscles  that  animate  the  hand  and  ringers 
are  lodged  beyond  in  the  fore-arm.  The  hysteric 
person  who  paralyzes  her  hand  seems  not  to  know  that 


158      The  Major  Symptoms  of  Hysteria 

the  immobility  of  her  fingers  is  due  in  reality  to  a  mus- 
cular disturbance  in  her  fore-arm.  She  stops  her 
anesthesia  at  the  wrist,  as  would  the  vulgar,  who,  in 
their  ignorance,  say  that  if  the  hand  does  not  move, 
it  is  because  the  hand  is  diseased.  Now  this  popular 
conception  of  the  limbs  is  formed  by  old  ideas  we  have 
about  our  limbs,  which  we  all  keep  in  spite  of  our 
anatomic  notions.  So  these  hysteric  anesthesias  seem 
again  to  have  something  mental,  intellectual,  in  them. 

This  characteristic,  though  really  very  important, 
might  still,  however,  give  rise  to  some  cavilling.  There 
are  in  intoxications,  in  alcoholism,  for  instance,  in- 
sensibilities in  the  form  of  a  sock  or  a  boot.  In  the 
medulla,  segmental  localizations  have  been  studied  that 
may  lead  one  to  conceive  anesthesias  of  the  same  kind. 
Practically,  you  will  be  right  nine  times  out  of  ten  in 
basing  a  diagnosis  of  hysteric  paralysis  on  this  geometric 
form  of  anesthesia,  but,  in  order  to  avoid  the  least 
chances  of  error,  we  must  insist  on  the  last  characteristic, 
to  which  we  have  just  come,  namely  the  mental  char- 
acter of  this  anesthesia.  It  is,  moreover,  this  character 
which  will  enable  us  to  arrive  at  a  more  intelligible 
conception  of  the  paralysis  itself.  Such  will  be  the 
object  of  our  next  lesson. 


LECTURE  VIII 

THE  PSYCHOLOGICAL  CONCEPTION  OF 
PARALYSES  AND  ANESTHESIAS 

The  problem  of  hysterical  anesthesias  —  Absence  of  any 
modification  of  the  reflexes,  of  any  physiological  dis- 
turbance—  Indifference  of  the  patient  —  Mobility  of  the 
anesthesia  under  various  influences,  attack,  sleep,  intoxi- 
cation, somnambulism,  suggestion,  emotion,  and  above  all 
attention  —  Contradictory  character  of  this  anesthesia  — 
The  part  played  by  absent-mindedness  —  The  dissociation 
of  certain  groups  of  sensations  in  the  anesthesia — The 
indifference,  the  lack  of  representation  and  memory  in  the 
paralysis —  The  astasia- abasia —  The  systematic  paraly- 
ses —  The  dissociation  of  a  system  of  movements  —  The 
system  of  movements  and  sensations  in  a  function  — 
Hemiplegy  and  paraplegy  as  dissociations  of  functions 

THE  time  has  now  come  to  give  our  attention  to  some 
psychological  studies  on  hysteria  that  had  a  great 
development  in  France  about  twenty  years  ago,  and 
have  contributed  much  to  the  development  of  patho- 
logical psychology.  They  are  perhaps  rather  special, 
having  perhaps  a  less  general  importance  than  we  then 
thought,  but  without  them  we  could  not  understand 
the  particular  nature  of  hysterical  anesthesia,  nor  even 
perhaps  form  with  sufficient  clearness  a  general  idea  of 
the  hysterical  disease  itself  and  especially  of  the  paraly- 


160      The  Major  Symptoms  of  Hysteria 

ses  that  exist  in  this  disease.  We  shall  insist  on  the 
mental  characters  of  anesthesia,  and  try  to  derive  from 
them  a  general  conception,  and  then  we  shall  see  that 
it  finds  its  application  in  the  study  of  paralyses,  which 
we  shall  take  up  again  from  a  new  point  of  view. 


We  have  already  seen  that  hysterical  anesthesia 
presents  certain  oddities  which  ought  to  attract  the 
physician's  attention.  It  is  accompanied  by  a  very 
deep  and  even  exaggerated  paralysis,  and  yet  does  not 
determine  any  serious  objective  disturbance.  Is  it 
not  odd  to  see  a  limb  remaining  quite  insensible,  quite 
paralyzed  for  months  and  sometimes  years  together 
without  any  serious  atrophy,  without  any  modification 
of  the  electric  reactions  and,  above  all,  without  any 
change  in  the  reflexes?  Certain  reflexes  in  particular 
astonish  us  very  much;  the  reflexes  of  the  erectile 
organs,  those  of  pain  remain  intact.  You  know,  for 
instance,  that  if  you  determine  a  strong  pain  by  pinch- 
ing the  skin  at  any  point  whatever  of  the  body,  the  pupils 
contract  suddenly.  This  fact  persists  with  our  hys- 
tericals  who  declare  they  feel  nothing.  The  vascular 
reflexes  in  relation  to  the  sensations  of  cold  and  heat 
are  very  delicate.  M.  Hallion  recently  contrived  to 
study  them  with  great  accuracy  by  means  of  a  delicate 
little  apparatus  which  he  invented.  The  application 
of  a  little  ice  on  the  fore-arm  immediately  brings  about 
the  contraction  of  all  the  vessels  of  the  hand.  At  my 
request  he  was  so  kind  as  to  study  the  fact  with  my 


The  Psychological  Conception          161 

patients,  and  found  that  the  most  anesthetic  hystericals 
reacted  quite  correctly  in  this  respect. 

Besides,  we  know  quite  well  what  the  disappearance 
of  the  cutaneous  sensations  produces,  in  practice.  Phys- 
iologists have  shown  that  when  the  limb  of  an  animal 
is  made  insensible  by  the  section  of  the  sensitive  root, 
this  limb,  quite  intact  at  first,  cannot,  nevertheless,  be 
preserved ;  it  is  not  long  in  becoming  unclean  and  cov- 
ered with  sores,  and  it  disappears  little  by  little,  for 
the  animal  itself  bites  it  off.  Sensibility  is  a  safeguard 
for  our  limbs.  We  may  observe  the  fact  in  a  well-known 
disease.  You  know  those  patients  who  come  to  the 
consultation  to  complain  that  their  hands  are  constantly 
burnt  or  wounded.  They  have  scars  of  burns  on  their 
fingers  and  are  not  able  to  avoid  this  accident.  They  are 
syringomyelic  patients  and  the  lesion  of  their  spines 
makes  them  insensible  to  cold  and  heat.  Why  is 
there  nothing  of  the  kind  to  be  found  in  our  anesthetic 
hystericals  ? 

This  absence  of  objective  disturbances  is  mostly 
accompanied  by  a  very  curious  subjective  symptom; 
namely,  the  indifference  of  the  patient.  When  you 
watch  a  hysterical  patient  for  the  first  time,  or  when  you 
study  patients  coming  from  the  country,  who  have 
not  yet  been  examined  by  specialists,  you  will  find,  like 
ourselves,  that,  without  suffering  from  it  and  without 
suspecting  it,  they  have  the  deepest  and  most  extensive 
anesthesia.  Lasegue,  who  analyzed  very  carefully 
many  of  the  subjective  characteristics  of  hysteria,  has 
often  pointed  out  this  ignorance  among  the  patients. 
Charcot  has  often  insisted  on  this  point  and  shown  that 


1 6a      The  Major  Symptoms  of  Hysteria 

many  patients  are  much  surprised  when  you  reveal 
to  them  their  insensibility.  Recent  authors  are  also 
agreed  on  this  point.  It  is  far  from  being  the  case  with 
anesthesias  of  organic  origin.  That  particular  symp- 
tom of  tabes,  which  Charcot  was  one  of  the  first  to 
describe  and  which  he  has  called  the  tabetic  mask, 
is  well  known.  The  patients  lose  the  sensibility  of  a 
part  of  the  face,  more  or  less  extensive,  but  they  account 
for  it  subjectively,  and  declare  that  they  experience 
a  horrible  feeling  in  regard  to  it.  Ask  hystericals  who 
have  facial  anesthesia  —  and  they  are  legion  —  whether 
they  experience  a  horrible  feeling  about  it,  and  they  will 
all  tell  you  that  they  do  not  care. 

To  explain  precisely  this  important  difference  between 
hysterical  anesthesia  and  anesthesia  of  organic  origin,  it 
will  not  be  out  of  place,  we  think,  to  relate  a  little  anec- 
dote. We  did  not  obtain  it  ourselves,  but  it  was  given 
to  us  by  our  brother,  Dr.  Jules  Janet.  When  he  was 
house  surgeon  at  the  Pitie  with  Dr.  Polaillon,  he  had  an 
opportunity  to  observe  the  following  case :  A  young  girl 
of  about  twenty  had  met  with  a  rather  serious  accident. 
She  fell  through  a  glass  door,  and  a  piece  of  glass  cut 
into  her  right  wrist  just  below  the  thenar  eminence. 
The  hemorrhage  was  stopped,  and  the  wound  had  united 
fairly  well  when,  a  few  days  after  the  accident,  the  young 
woman  presented  herself  for  treatment.  She  expe- 
rienced a  certain  numbness  in  her  right  hand,  but  no 
paralysis  was  present.  She  complained  particularly 
of  a  persistent  insensibility,  most  inconvenient,  in  the 
palm  of  the  hand ;  this  slight  anesthesia  about  the  fingers 
was  in  fact  complete  at  the  level  of  the  thenar  eminence. 


The  Psychological  Conception  163 

The  case  was  evidently  one  of  a  more  or  less  complete 
severing  of  the  median  nerve,  and  especially  of  its  super- 
ficial branches.  But  while  accepting  the  observation 
of  the  patient,  we  made  a  singular  discovery.  She 
was  a  hysterical,  and  on  her  entire  left  side  she  was 
completely  anesthetic,  of  which  fact  she  had  not  said  a 
word.  The  physician  joked  her  about  it :  "How  is  it, 
miss,  that  you  come  here  complaining  about  an  insen- 
sibility that  affects  but  a  small  portion  of  the  palm  of 
your  right  hand,  while  you  do  not  even  notice  the  much 
larger  insensibility  of  the  whole  of  your  left  side  ?  "  The 
poor  girl  looked  surprised  and  ashamed.  To  our  mind 
she  might  have  replied  to  her  doctor  with  much  more 
assurance,  and  said :  "  Be  that  as  you  think,  sir,  I 
came  here  to  tell  you  what  ails  me ;  it  is  the  insensibility 
of  the  palm  of  my  right  hand  that  troubles  me,  and  that 
of  my  left  side  has  never  given  me  any  trouble.  You  are 
the  doctor;  explain  it  as  you  like." 

To  these  general  remarks  must  be  added  all  that 
we  have  already  said  on  the  form  of  these  anesthesias, 
a  form  which  has  nothing  anatomic  or  even  scientific 
in  it  and  seems  to  correspond  to  false  popular  notions. 
These  remarks  compel  us  to  enter  more  deeply  into 
the  scrutiny  of  the  mental  state  corresponding  to  these 
strange  insensibilities.  This  study  leads  us  now  to 
point  out  a  new  characteristic  in  the  same  order  of 
ideas,  namely,  the  remarkable  mobility  of  these  anes- 
thesias. 

Unquestionably,  some  patients  retain  their  stigmata 
all  their  lives.  Aurel.  is  still  hemianesthetic  at  seventy- 
five;  Ler.  has  kept  a  hemianesthesia  and  a  contraction 


164      The  Major  Symptoms  of  Hysteria 

of  the  visual  field  for  forty  years.  We  shall  have  to  keep 
an  account  of  these  cases;  but  generally,  and  perhaps 
even  among  these  very  patients,  without  its  having 
been  observed,  anesthesia  becomes  modified  and  dis- 
appears all  at  once  for  longer  or  shorter  periods.  It 
varies  from  one  moment  to  another,  says  M.  Fere",  and 
under  the  influence  of  causes  so  slight  that  they  may 
pass  unnoticed. 

However  rapid  in  their  mobility,  some  of  these  changes 
may  nevertheless  be  studied,  and  one  can  note  at  least 
some  of  the  circumstances  in  which  they  are  oftenest 
affected.  The  attacks  modify  considerably  the  locali- 
zation of  sensibility.  Many  authors  have  noted 
that  anesthesias  often  increase  at  the  time  preceding 
the  attacks.  For  example,  Marguerite  X.,  who  or- 
dinarily has  right-sided  hemianesthesia,  becomes,  dur- 
ing the  hours  that  precede  the  attack,  totally  anes- 
thetic. We  point  out  a  case  much  rarer  still;  it  is 
an  opposite  phenomenon.  Cel.,  usually  totally  anes- 
thetic, recovers  complete  sensibility  sometimes  during 
a  form  of  excitement  which  lasts  half  an  hour  before 
the  attack. 

During  the  attack  itself,  when  we  can  obtain  some 
intelligent  sign  (we  have  seen  that  it  is  generally  pos- 
sible), the  sensibility  becomes  modified.  Often,  as 
happens  with  Bert.,  it  is  recovered  entirely.  After 
the  attack,  many  patients,  like  Marg.,  return  to  their 
usual  condition ;  others  have  for  some  time  anesthesias 
more  extended  than  usual.  Bert.,  generally  hemianes- 
thetic  on  the  left  side,  remains,  after  the  attack,  totally 
anesthetic  and  at  times  completely  blind  for  some  hours. 


The  Psychological   Conception  165 

It  often  happens,  during  natural  sleep  at  night,  that 
tactile  anesthesias  disappear.  It  is  very  difficult  to 
verify  the  fact.  We  have  to  take  the  patients  by  sur- 
prise at  night,  using  all  sorts  of  precautions  not  to 
wake  them.  We  pinch  them  on  the  anesthetic  side. 
They  groan,  turn  over,  complain  in  their  dream,  or 
wake  suddenly,  exactly  as  a  normal  person  would. 
M.  Jules  Janet,  when  he  was  an  assistant  of  Dumont- 
pallier,  has  repeatedly  verified  this  fact  on  two  patients, 
the  observation  of  which  he  communicated  to  us.  We 
had  the  fact  established  on  various  persons,  particu- 
larly on  Bert,  and  Is.  Our  friend,  M.  Dutil,  was 
kind  enough  to  verify  the  fact  for  us  on  a  hysterical,  G., 
hemianesthetic  on  the  left  side.  Pinched  on  that  side 
during  her  natural  sleep,  she  winced  and  spoke  in  her 
dream :  "You  are  pinching  me  —  how  stupid  — " 

During  certain  intoxications  that  bring  with  them 
states  analogous  to  sleep,  insensibility  vanishes  more 
or  less  completely:  many  patients,  totally  anesthetic, 
become  entirely  sensitive  when  drunk.  Chloroform- 
anesthesia  in  the  period  of  excitation  does  away  with 
all  stigmata,  with  the  anesthesia  as  well  as  the  con- 
tractures.  "Among  the  most  paradoxical  consequences 
of  the  hypodermic  use  of  morphine,"  says  Mr.  Ball, 
"we  must  cite  the  restoration  of  cutaneous  sensibility 
with  subjects  who  have  lost  it.  ...  A  hysterical, 
drugged  with  morphine,  a  dose  of  eight  centigrammes 
a  day,  felt  all  her  pain  disappear  and  her  normal  sensi- 
tiveness restored.  Abstinence  brought  back  her  hys- 
terical symptoms."  The  same  fact  has  been  described 
by  M.  Jules  Voisin.  In  the  same  manner  we  see  often 


1 66      The  Major  Symptoms  of  Hysteria 

a  diminution  of  the  anesthesia  and  a  widening  of  the 
visual  field  in  hystericals  who  are  under  the  influence 
of  morphine,  and  we  could  verify  too  the  reappearance 
of  the  anesthesia  after  the  cessation  of  the  influence  of 
the  drug.  Many  other  excitations  must  have  analogous 
effects. 

The  object  of  our  first  work  *  was,  above  all,  the  nu- 
merous modifications  of  sensitiveness  during  states 
of  induced  somnambulism.  Certain  subjects,  under 
rare  conditions,  recover  suddenly  and  completely  all 
their  sensitiveness  as  soon  as  they  are  in  the  second  state. 
This  fact  has  been  sometimes  pointed  out  in  old  de- 
scriptions of  the  magnetizers.  We  have  very  often 
established  these  same  facts  at  the  outset  of  our  re- 
searches before  we  had  read  the  very  interesting  obser- 
vations of  these  authors.  Sometimes  the  subjects  have, 
during  their  somnambulism,  an  anesthesia  apparently 
general;  but  the  slightest  excitation  that  directs  their 
attention  somewhat  upon  tactile  sensitiveness  causes 
this  anesthesia  to  disappear,  even  on  parts  that  re- 
mained anesthetic  when  awake,  despite  suggestions. 
This  restoration  to  sensitiveness  of  some  subjects 
proceeds  somewhat  slowly  and  becomes  evident  only 
when  the  hypnotic  state  has  been  considerably  pro- 
longed. Others  again  have  a  more  complicated  som- 
nambulism; they  pass  through  several  states  in  which 
sensibility  and,  above  all,  memory  undergo  many  modi- 
fications. It  is  only  in  one  of  these  states,  often  a  state 
that  develops  after  all  the  others,  that  the  subjects 
recover  all  their  sensibilities. 

1  "  L'automatisme  psychologique,"  1889. 


The  Psychological  Conception  167 

Sensibility  may  be  modified  even  in  waking  time. 
Briquet  has  insisted  on  the  action  of  electricity ;  Burcq 
and  many  others  after  him  have  shown  that  magnets, 
metal  plates,  and  many  other  agents,  which  all  vary 
according  to  the  patients,  have  analogous  effects.  The 
sensibility,  increased  by  these  agents,  persists  for  a 
longer  or  shorter  time  and  disappears  with  oscillations. 

The  influence  of  suggestion,  in  general  very  powerful 
with  hystericals,  may  suffice  momentarily  to  reestablish 
the  sensibility,  but  it  should  be  borne  in  mind  that  this 
phenomenon  is  far  from  being  general,  that,  with  a 
number  of  patients,  sensibility  changes  very  little  when 
it  is  suggested,  and  on  the  contrary  undergoes  great 
modifications  under  the  influence  of  certain  excitations, 
such  as  drunkenness,  or  certain  changes  of  psychological 
state,  as  somnambulism. 

Many  other  psychological  phenomena  come  in  to 
produce,  modify,  or  destroy  anesthesia.  For  example, 
strong  emotion,  preoccupation,  reveries,  increase  it. 
The  association  of  ideas  may  in  some  cases  modify  it. 
We  say  to  one  patient  that  she  has  a  caterpillar  on  her 
left  hand,  and  she  cries  out  and  pretends  that  she  feels 
the  tickling  of  it ;  at  this  moment  the  whole  of  her  left 
arm  has  become  quite  sensitive. 

But  there  is  a  psychological  phenomenon  which  plays 
a  far  more  important  part  than  any  other,  and  its  study 
throws  a  great  deal  of  light  upon  the  problem;  we 
mean  attention.  To  verify  this  fact,  we  must  remember, 
as  we  shall  demonstrate  later,  that  with  hystericals 
attention  is  altogether  the  most  difficult  thing  to  fix,  and 
that  only  a  few  can  succeed  in  directing  it.  As  a  gen- 


i68      The  Major  Symptoms  of  Hysteria 

eral  thing,  we  may  for  a  moment  attract  their  attention 
upon  their  anesthetic  hand  by  whatever  means  we 
please.  A  patient  does  not  feel  the  electric  current 
when  he  has  his  eyes  shut.  He  acknowledges  a  tickling 
on  seeing  the  manipulation  of  the  process.  We  fasten 
a  red  wafer  on  Bert.'s  left  hand,  she  looks  astonished 
and  stares  at  her  hand.  Let  us  leave  her  for  a  moment ; 
then,  when  her  head  is  turned,  let  us  lightly  pinch  that 
hand,  so  insensible  but  a  moment  ago.  Bert,  now  cries 
out  when  we  pinch  her  and  feels  it  quite  perfectly. 
It  is  true  that  this  fine  sensibility  will  not  last  long. 
We  take  that  wafer  off  and  a  few  minutes  later  she  can 
no  longer  feel  anything.  All  these  phenomena,  the 
last  particularly,  are  the  origin  of  many  difficulties, 
for  they  very  easily  upset  the  sensibility  that  is  the  object 
of  the  study.  They  increase  the  anesthesia,  they  fix 
it,  or  suppress  it ;  they  give  it  an  extremely  changeable 
aspect,  which  discourages  the  observer. 

Now  it  will  be  asked,  does  the  anesthesia,  at  least 
as  long  as  it  exists,  present  itself  to  the  observer  defi- 
nitely ?  Is  it  always  very  certain,  in  whatever  way  you 
examine  the  subject  ?  By  no  means ;  and  we  have  to 
point  out  a  second  series  of  observations  which  com- 
plicate the  problem  of  anesthesia  still  more,  for  they 
present  it  to  us  not  only  as  changeable,  but  as  contra- 
dictory. 

Lasegue  said  in  1864  that  hysterical  anesthesia  looked 
strange,  and  that  it  seemed  to  be  a  psychological  per- 
turbation, a  sort  of  alienation.  The  studies  which  sub- 
sequently confirmed  this  theoretical  conception  were 
at  first  observations  on  an  altogether  special  point, 


The  Psychological  Conception  169 

namely,  on  unilateral  amaurosis;  that  is,  on  certain 
very  interesting  disturbance  of  the  vision,  about  which 
we  shall  speak  in  our  next  lesson. 

If  the  unilateral  amaurosis  presents  embarrassing 
problems,  it  is  the  same  with  all  anesthesias.  Several 
years  ago,  we  made  the  following  observation  of  a 
patient  in  M.  Powilewic's  service  at  the  Havre  hospital. 
She  was  attacked  with  hysterical  paraplegia  and  pre- 
sented a  state  of  total  anesthesia.  We  used  to  treat 
her  legs  with  electricity,  and  noticed  the  strong  muscular 
contractions  she  experienced  at  each  contact  of  the 
negative  electrode,  when  all  at  once  we  saw  that  the 
two  wires  which  fastened  the  plugs  to  the  apparatus 
had  dropped.  For  a  long  time  we  had  thus  been  apply- 
ing electricity  with  mere  pieces  of  wood.  We  continued 
without  fastening  the  wires  to  the  ends,  and  the  con- 
tractions were  all  the  greater  by  the  simple  contact  of 
the  plug.  This,  it  will  be  said,  is  nothing  very  wonder- 
ful ;  there  is  a  sort  of  habit  in  that  a  suggestion  is  taking 
place.  We  think  so  too ;  but  how  could  this  patient, 
whose  skin  all  over  her  body  was  wholly  insensible, 
and  with  her  head  well  turned  away,  feel  the  moment 
when  the  plug  touched  her  legs,  and  make  a  movement 
just  then  and  only  just  then?  We  may  every  day  ex- 
perience a  similar  embarrassment.  We  propose  to 
Is.  a  little  contrivance  to  verify  her  anesthesia  quickly. 
She  is  to  answer  "  Yes"  when  she  feels  and  " No"  when 
she  does  not  feel  anything.  As  she  is  very  simple- 
minded,  she  accepts  without  demurring,  and  we  dis- 
cover then  a  furious  contradiction.  Although  she  has 
her  eyes  carefully  concealed  behind  a  screen,  although 


170     The  Major  Symptoms  of  Hysteria 

we  avoid  any  kind  of  rhythm  and  pinch  her  several 
times  irregularly  on  the  same  side  before  we  pass  over 
to  the  other,  she  is  never  mistaken,  and  always  says 
"Yes"  when  we  pinch  her  on  the  left  and  "No"  when 
we  pinch  her  on  the  right.  The  same  experiment 
repeated  on  a  man,  Pasq.,  gives  exactly  the  same  results, 
until  he  perceives  the  queerness  of  his  answers  and  tries 
to  answer  attentively.  He  then  ceases,  but  only  then, 
to  say  "No"  when  we  pinch  his  anesthetic  side. 

Here  now  is  another  observation  which  bears  no 
longer  on  the  tactile  but  on  the  muscular  sense.  A 
young  woman,  twenty-two  years  old,  whom  we  have  often 
described  by  the  name  of  Lucy,  took  during  her  attacks 
certain  cataleptic  poses.  For  an  hour,  she  would  keep 
her  eyes  fixed  on  the  window  and  her  arms  raised  in  an 
attitude  of  terror.  For  the  present  we  must  insist 
on  only  one  detail  of  this  attack;  we  observed  that 
during  the  most  normal  of  her  waking  states,  it  was 
enough  to  raise  both  her  arms,  and  place  them  in  the 
posture  of  terror  which  they  took  during  her  crisis, 
to  induce  at  once  an  attack.  Of  course,  you  will  say 
the  thing  is  quite  simple  and  well  known.  By  the 
position  of  the  arms  you  call  forth  the  principal  idea 
of  attack,  and  the  rest  follows.  True,  but  there  is  a 
little  detail  yet.  Lucy  was  anesthetic  over  her  entire 
body  and  presented  nowhere  any  trace  of  muscular 
sense.  As  often  happens  in  this  case,  she  would  fall 
down  at  once  as  soon  as  you  closed  her  eyes.  Now, 
we  have  often  taken  the  precaution  to  close  her  eyes 
before  displacing  her  arms,  and  the  crisis  occurred  all 
the  same  as  soon  as  the  members  had  the  required  posi- 


The  Psychological  Conception          171 

tion.  How  do  you  explain  the  notion  of  that  position 
being  appreciated  by  so  insensible  a  subject?  All 
these  facts  and  a  great  number  of  others  which  have 
been  accumulated  are  very  likely  to  puzzle  the  observer. 
They  show  us  that  hysteric  anesthesia  not  only  changes 
from  one  moment  to  another,  but,  indeed,  varies  in  the 
same  instant  and  manifests  itself  by  contradictory 
phenomena  according  to  the  questions  put  to  the  subject. 

II 

We  must  rapidly  lay  aside  a  first  interpretation  of 
these  facts.  The  anesthesia  of  hystericals  is  extremely 
changeable  and  contradictory.  These  patients  pretend 
not  to  feel,  and  by  very  simple  artifices  we  can  prove 
to  them  that  they  feel  perfectly  well.  Their  insensi- 
bility is,  therefore,  simulated,  and  our  processes  are 
only  means  to  deceive  a  deceiver  and  unmask  a  fraud. 
This  risumt  of  facts  is,  to  our  mind,  altogether  crude 
and  insufficient.  Do  hystericals  take  any  particular 
interest  or  pleasure  in  having  their  arms  pierced  through 
with  needles?  Do  these  young  girls  pass  through  the 
council  of  revision  to  simulate  unilateral  amaurosis? 
How  is  it  that,  in  all  civilized  countries,  hystericals 
should  have  agreed  to  simulate  the  same  thing  ever  since 
the  Middle  Ages  to  the  present  day  ? . 

We  must  not  be  content  with  this  crude  explanation, 
and  since  anesthesia  presents  itself  to  us  as  a  psycho- 
logical fact,  we  must  seek,  among  the  few  notions 
psychology  furnishes  us,  that  which  best  summarizes 
facts  of  this  kind.  We  are  happy  to  have  Lasegue 


172      The  Major  Symptoms  of  Hysteria 

confirm  an  opinion  which  we  have  maintained  for 
several  years ;  hysterical  anesthesia  is  a  certain  species 
of  absent-mindedness.  "A  person,"  said  Lasegue 
in  1864,  "absent-minded  through  a  great  preoccupation, 
does  not  perceive  sensations  which,  in  another  frame 
of  mind,  he  would  scarcely  have  tolerated.  ...  It 
is  probable  that  hystericals,  whose  moral  state  offers 
so  many  other  singularities,  acquire  likewise,  through 
their  very  malady,  a  sort  of  laziness  that  renders  them 
less  apt  to  perceive  certain  psychic  modalities." 

This  explanation  based  on  absent-mindedness  is,  in 
reality,  but  a  first  approximation.  Anesthesia  is  surely 
not  ordinary  absent-mindedness;  it  has  much  more 
clearness  and  duration.  It  is  far  from  disappearing  so 
easily  as  soon  as  the  subject  chooses,  and  above  all, 
it  appears  without  there  being  any  fixed  idea  of  any 
object  which  attracts  the  patient's  attention  to  another 
point.  There  is  in  it  a  pathological  incapacity  to 
collect  the  elementary  sensations  in  a  general  perception. 
In  reality  what  has  disappeared  is  not  the  elementary 
sensation,  the  preservation  of  which  we  have  just  seen ; 
it  is  the  faculty  that  enables  the  subject  to  realize  this 
sensation,  to  connect  it  with  his  personality,  to  be  able 
to  say  clearly :  "  It  is  I  who  feel,  it  is  I  who  hear." 

We  shall  .often  have  the  opportunity  to  reconsider 
this  problem,  but  let  us  remark,  by  the  way,  that  this 
singular  character  of  anesthesia  is  not  unknown  to  us ; 
after  all,  we  have  already  seen  something  similar  while 
studying  the  amnesias  that  follow  somnambulisms. 
I  have  already  told  you  that  the  subjects  were  unable 
to  remember  what  had  happened  during  the  fit  of 


The  Psychological  Conception          173 

somnambulism,  and  even  to  remember  the  principal 
idea  which  played  a  part  in  this  state.  Irene,  whom  I 
have  repeatedly  spoken  of,  had  forgotten  after  the  crisis 
not  only  the  comedy  she  had  played  but  also  her  mother's 
death  and  illness,  which  were  its  starting  point. 

We  accepted  at  that  moment,  without  discussing  it, 
the  description  of  this  amnesia,  for  we  did  not  want  to 
complicate  the  matter,  but  in  reality  that  oblivion  was 
very  strange.  Was  it  real  oblivion,  the  obliteration  of 
the  recollections,  the  destruction  of  the  images  ?  By  no 
means,  since  the  patient  could  be  cured  and  is  now 
able  to  relate  clearly  all  those  events.  Was  it  then  the 
inability  to  reproduce  them?  Was  it  that  the  brain, 
while  keeping  their  traces,  was  nevertheless  not  able 
consciously  to  cause  them  to  reappear?  By  no  means, 
since  the  patient  had  dreadful  fits  every  day  during 
which  she  recited  all  the  details  of  the  events.  In  a 
word,  she  had  forgotten  nothing  and  she  had  the  power 
to  recite  everything.  Then  where  was  the  oblivion? 
The  oblivion  consisted  only  in  this,  that  she  could  not 
recite  in  a  waking  state,  with  full  consciousness  of  the 
other  events  and  of  herself.  She  could  relate,  it  is  true, 
but  in  a  dream,  in  a  delirium,  without  having  at  the 
same  time  the  notion  of  herself.  As  soon  as  she  had 
the  personal  consciousness  of  her  name,  of  her  situation, 
she  could  no  longer  associate  the  remembrance  in 
question.  We  tried  to  sum  this  up  by  saying  that 
somnambulism  is  not  the  destruction  of  an  idea  but 
the  dissociation  of  an  idea,  that  has  emancipated  itself 
from  the  ensemble  of  consciousness,  and  that  the  en- 
semble of  consciousness  can  neither  recover  nor  control. 


174      The  Major  Symptoms  of  Hysteria 

Well,  our  anesthesias,  which  looked  so  strange,  have 
just  presented  to  us  the  very  same  characters  with  more 
clearness  still.  They  are  groups  of  sensations  forming 
a  kind  of  system,  that  is  to  say  the  ensemble  of  sensations 
coming  from  the  hand  or  the  leg,  which  can  no  longer 
be  connected  with  the  totality  of  consciousness,  although 
they  still  exist  on  their  own  account  and  even  determine 
reflexes  and  usual  movements. 

Let  us  apply  the  same  notion  to  our  paralyses;  we 
shall  see  that  the  facts  are  absolutely  of  the  same  kind. 
Besides  anesthesia,  on  which  we  dwelt  for  some  time, 
there  are  other  mental  phenomena  which  accompany 
hysterical  paralyses.  The  most  curious  are  connected 
with  a  kind  of  indifference,  analogous  to  the"  one  we 
remarked  in  anesthesia.  If  we  had  a  paralyzed  arm,  it 
would  inconvenience  us  exceedingly,  we  should  fret 
very  much  about  .this  disease,  we  should  perpetually 
regret  our  former  state  and  be  forever  making  desperate 
efforts  to  recover  the  motion  we  had  lost.  We  cannot 
help  therefore  being  somewhat  surprised  and  ill-hu- 
moured when  we  attend  a  paralyzed  hysterical.  This 
kind  of  patients  vexes  us  with  their  calm  indifference  and 
inertia.  One  of  their  limbs  being  out  of  use  does  not 
appear  to  incommode  them ;  they  think  it  quite  natural 
to  walk  with  but  one  leg,  and  do  not  make  the  least 
effort  to  use  the  other  leg.  It  was  just  this  that  deter- 
mined the  famous  distinction  Charcot  made  between 
the  helicopode  and  helcopode  gaits.  While  the  person 
affected  with  organic  hemiplegy  labours  hard  to  move 
his  restive  limb  forward,  the  hysterical  drags  hers  after 
her  like  a  cannon-ball.  She  almost  despises  it,  and 


The  Psychological  Conception          175 

she  wants  to  beat  it,  calling  it  "an  old  stump,"  like 
a  patient  Professor  James  has  described.1 

This  conduct  corresponds  to  a  very  special  mental 
trouble.  If  you-  question  such  persons,  you  find  that 
they  seem  not  to  have  kept  the  remembrance  of  their 
limb,  they  do  not  know  any  longer  what  this  paralyzed 
limb  used  to  do  and  they  can  no  longer  make  the  efforts 
of  imagination  necessary  to  conceive  it.  Fe"r£  was  one 
of  the  first  who  insisted  on  this  point.  "After  having 
shut  the  patient's  eyes,"  he  says,  "I  ask  her  to  try  to 
represent  to  herself  her  left  hand  executing  movements 
of  extension  and  flexion.  She  is  not  able  to  do  it.  She 
can  represent  to  herself  her  right  hand  making  very 
complicated  movements  on  the  piano,  but  on  her  left, 
she  has  the  sensation  that  her  hand  is  lost  in  empty 
space.  She  cannot  even  represent  to  herself  its  form.2" 
I  have  verified  this  remark  more  than  twenty  times. 
This  lack  of  representation  and  memory  of  the  paralyzed 
limb  is  one  of  the  most  typical  things ;  many  authors 
have  remarked  it.  Here  is  the  statement  of  an  English 
author,  Dr.  Bastian,  who,  by  the  way,  has  quite  another 
conception  of  hysteria  than  we;  "When  I  ask  her  if 
she  can  imagine  that  she  touches  the  tip  of  her  nose 
with  her  left  finger,  she  immediately  answers:  'Yes.' 
If  I  ask  her  to  imagine  the  same  movements  with  the 
paralyzed  hand,  she  remains  hesitating  and  at  last 
answers:  'No.'  She  can  imagine  herself  playing  on 

1  William  James,  "  Notes  on  Automatic  Writing."     Proceedings  oj 
the  Society  oj  Psychical  Research,  March,  1889,  p.  552,  and  in  "The 
Principles  of  Psychology,"  1890,  I,  p.  377. 

2  Ch.  F6i6,  "La  Pathologic  des  Emotions,"  1892,  p.  143. 


176      The  Major  Symptoms  of  Hysteria 

the  piano  with  her  left  hand  but  not  with  her  right 
hand."1 

The  same  remark  applies  to  the  old  observations  made 
at  the  outset  on  the  will  of  these  patients.  The  English 
author  Brodie  had  already  said :  "  In  hysterical  paralysis, 
it  is  not  the  muscles  which  do  not  obey  the  will,  it  is 
the  will  itself  which  does  not  enter  into  the  action." 
W.  Page  added:  "When  the  patient  says:  'I  cannot,' 
it  means,  'I  cannot  will';"  and  M.  Huchard  said: 
"They  cannot,  they  will  not  will."  What  did  these 
remarks,  applied  to  paralytics,  mean?  They  meant 
that  the  patient  did  not  seem  to  make  the  initial  effort, 
to  apply  his  consciousness  to  a  certain  act.  He  did  not 
even  seem  to  have  the  representation  of  this  act.  All 
these  remarks  are  of  about  the  same  kind,  and  we  find 
again  in  paralyses  dissociations  of  psychological  phe- 
nomena identical  with  those  we  have  observed  in 
somnambulic  amnesias. 

There  is  but  one  difficulty  left.  What  is  the  psycho- 
logical phenomenon  that  dissociates  itself?  In  som- 
nambulism, it  was  the  idea  of  an  event,  and  was  rela- 
tively clear;  but  have  we  in  our  mind  the  idea  of  the 
motion  of  our  two  legs  ?  Is  it  this  idea  that  disappears 
in  its  entirety  and  makes  us  lose  the  motion  of  our  legs  ? 
It  seems  very  odd,  and  we  are  not  accustomed  to  apply 
the  word  idea  to  the  ensemble  of  the  movements  of  our 
two  legs.  To  make  the  thing  clear,  we  must  now  recall 
certain  forms  of  paralyses  of  which  I  have  not  yet 
spoken  and  which  will,  I  think,  form  the  transition 

1  Charlton  Bastian,  "  Various  Forms  of  Hysterical  or  Functional 
Paralysis,"  1893,  p.  15. 


The  Psychological  Conception  177 

between  the  preceding  phenomena  of  dissociation  and 
the  great  paralyses  which  we  do  not  understand. 

Ill 

Several  authors,  one  of  the  first  of  whom  was  Jaccoud, 
and  among  whom  we  find  Charcot,  Blocq,  and  Se'glas, 
had  pointed  out  a  form  of  hysterical  paralysis  still  more 
extravagant  and  unintelligible  than  the  others. 

The  subjects  are,  as  a  rule,  young  people ;  they  seem 
not  to  have  the  least  paralysis  of  the  legs,  when  you  ex- 
amine them  in  their  bed.  Not  only  are  the  reflexes 
intact,  but  —  and  the  fact  is  more  surprising  —  the 
movements  are  intact.  If  you  tell  them  to  raise  their 
legs,  to  bend,  to  turn  them,  they  do  exactly  all  that 
is  required  of  them.  What  is  more,  they  have  kept  a 
very  great  strength,  quite  the  normal  strength.  They 
push  back  your  hand  with  their  feet,  they  lift  you  up  if 
you  bear  down  with  all  your  strength  on  their  knees. 
Then,  you  will  no  doubt  say,  there  is  nothing  at  all  the 
matter  with  them.  It  is  true,  but  they  are  absolutely 
incapable  of  walking.  If  you  cause  them  to  stand  on 
the  floor,  they  will  bend,  twist  their  legs,  throw  them 
to  one  side  and  the  other,  and  fall  down  without  having 
made  one  step  :  and  this  will  last  for  weeks  and  months. 
They  realize  the  paradox  of  having  no  paralysis  of 
the  legs  and  of  being  unable  to  walk.  In  a  few,  de- 
scribed by  Charcot,  the  comedy  is  still  more  complete ; 
they  are  able  to  make  with  their  legs  certain  movements 
which  seem  very  complicated,  as  jumping,  dancing, 
hopping  on  one  leg,  running,  but  they  fall  as  soon  as 
they  try  to  walk.  Can  you  conceive  such  an  absurdity  ? 


iy8      The  Major  Symptoms  of  Hysteria 

For  some  time  this  disease,  which  was  called  astasia- 
abasia,  seemed  to  be  almost  alone  of  its  kind,  but  soon 
physicians  were  obliged  to  recognize  that  there  were 
many  other  paralyses  belonging  to  the  same  type,  and 
that  they  were  even  frequent.  Some  subjects  are  still 
able  to  walk,  but  cannot  stand ;  others  have  lost  some 
functions  of  the  hands :  they  almost  always  forget  their 
trade;  a  needle- woman  can  no  longer  sew,  an  ironer 
can  no  longer  handle  an  iron,  though  they  have  no 
paralysis  of  the  hand.  Frequently  girls  can  no  longer 
write  at  all,  or  play  on  the  piano."  M.  Babinski  has 
shown  such  cases  for  the  functions  of  the  mouth ;  the 
patient  can  no  more  blow  or  whistle,  while  he  can  make 
all  the  other  movements  of  the  lips.  These  examples  are 
sufficient  to  prove  to  you  that  there  are  very  often 
systematic  paralyses  in  which  a  certain  system  of  move- 
ments, grouped  by  education,  separates  from  conscious- 
ness and  takes  an  existence  of  its  own. 

These  phenomena  come  much  nearer  to  our  som- 
nambulic  amnesia.  The  oblivion  of  her  mother's 
death  which  came  upon  one  of  our  patients,  and  of  all 
the  care  she  had  taken  of  her  during  her  illness,  was 
the  loss  of  a  system  of  images  and  movements  which 
comes  very  near  the  oblivion  of  sewing  or  writing.  You 
understand  that  in  these  two  cases,  the  group  and  the 
more  or  less  complex  system  are  of  the  same  kind. 
Well,  if  it  is  not  too  bold,  I  will  propose  to  you,  not  to 
consider  abasia  as  an  exceptional  hysterical  paralysis, 
but  on  the  contrary  to  make  it  the  type  of  all  the  other 
hysterical  paralyses. 

The  ensemble  of  the  movements  of  the  right  hand  is 


The  Psychological  Conception  179 

a  system  of  images  and  movements,  exactly  as  the  en- 
semble of  the  movements  necessary  to  play  on  the  piano. 
Only  it  is  a  much  more  extended  and,  above  all,  a  much 
older  system.  It  is  the  reason  why  it  contains  in  itself 
and  involves  all  the  sensations  of  the  hand,  whereas 
playing  on  the  piano  involved  only  certain  special 
sensations.  And  what  about  the  paralysis  of  the  two 
legs  ?  you  will  ask  me.  It  is,  in  my  opinion,  exactly  the 
same.  The  two  legs  form  a  unity,  not  only  anatomi- 
cally but  especially,  psychologically  speaking.  Our 
ancestors,  the  animals,  constructed  in  their  mind  the 
association  of  the  limbs  of  the  same  level,  of  the  same 
segment.  These  limbs  have  a  common  role  to  play: 
such  a  segment  enables  us  to  stand,  such  another  to 
seize  objects.  This  system  of  images  relative  to  the  two 
legs  is  very  vast ;  it  contains  subdivisions,  as  the  system 
that  concerns  walking,  or  jumping,  but  it  can  be  dis- 
sociated in  its  entirety.  Lastly,  since  we  are  making 
hypotheses,  we  must  not  stop  half  way;  hysterical 
hemiplegy  is  a  phenomenon  of  the  same  kind  as  astasia- 
abasia.  The  movements  of  one  side  of  the  body  also 
form  a  system :  we  have  a  very  clear  idea  of  the  ensemble 
of  the  actions  of  the  right  side  as  opposed  to  the  en- 
semble of  the  actions  of  the  left  side. 

No  doubt,  you  will  tell  me,  these  great  systems  of  sen- 
sations and  images  are  at  the  same  time  anatomical 
systems,  which  hav&  a  unity  in  the  brain  and  in  the 
spine.  I  do  not  deny  it  by  any  means;  the  fact  that 
a  system  is  psychological  should  not  cause  us  to  conclude 
that  it  is  not  at  the  same  time  anatomical.  On  the 
contrary,  the  one  involves  the  other.  When  I  begin  to 


180      The  Major  Symptoms  of  Hysteria 

learn  to  ride  a  bicycle,  I  voluntarily  group  together 
images  depending  on  several  centres  and  which  have 
never  been  grouped :  consequently  I  am  very  awkward. 
After  some  time,  I  can  maintain  my  equilibrium  on  a 
bicycle;  it  means  that  these  different  images  have  as- 
sociated together  and  regularly  call  forth  one  another. 
It  is  very  likely  that  this  functional  association  cor- 
responds to  an  anatomical  association  which  has  been 
effected  among  the  different  centres,  and  that  a  new 
little  centre  has  been  formed  in  my  brain,  the  centre 
concerning  bicycle  riding.  It  is  even  because  this  centre 
persists  and  develops,  that  next  year  I  shall  be  able  to 
ride  without  learning  again.  With  regard  to  new  func- 
tions, we  understand  easily  that  the  system  is  at  once 
mental  and  physical ;  but  you  should  impress  your  mind 
with  the  belief  that  your  ancestors,  the  monkeys,  learned 
to  walk  on  two  legs  as  you  have  learned  to  ride  a  bicycle, 
and  that,  before  the  monkeys,  there  were  other  beings 
who  learned  to  systematize  the  movements  of  one  side 
of  their  body  and  invented  the  right  side  and  the  left 
side.  This  very  old  function  has  well  organized  cen- 
tres, but  it  is  none  the  less  a  function,  that  is  to  say, 
a  complete  system  of  sensations  and  images. 

Well,  as  the  hysterical  may  lose,  while  they  have 
fits  of  somnambulism,  a  little  system  of  thoughts  that 
emancipates  itself,  which  loss  brings  on  two  symptoms, 
somnambulic  agitation  and  amnesia,  so  the  same  patients 
may,  in  the  same  way,  lose  through  dissociation  a  great 
and  old  system  of  thoughts  and  sensations,  that  of 
the  right  side  or  that  of  the  two  legs.  And  this  new 
dissociation  will  again  manifest  itself  by  two  great  symp- 


The  Psychological  Conception          181 

toms :  first,  by  involuntary  motor  agitations,  which  we 
studied  in  our  last  lecture  in  the  form  of  choreas  and  of 
more  or  less  extended  tics ;  and  secondly,  by  hysterical 
paralyses.  I  don't  insist  on  the  details  of  these  phenom- 
ena, on  the  different  degrees  of  these  paralyses;  it  is 
enough  to  have  presented  to  you  this  general  conception. 


LECTURE   IX 
THE   TROUBLES   OF   VISION 

The  troubles  of  different  perceptions,  touch,  smell,  taste, 
hearing  —  The  total  dissociation  of  the  function  of  vision 
— Hysterical  blindness —  The  partial  dissociation  of  vision 
—  Unilateral  amaurosis  —  The  contradictory  characters 
of  this  amaurosis  —  The  dissociation  of  the  monocular 
and  the  binocular  vision —  The  narrowing  of  the  visual 
field  —  The  dissociation  of  the  peripheric  and  central 
vision  —  The  problem  of  hysterical  hemianopsia  compared 
with  hysterical  hemiplegy  —  Dyschromatopsia  —  The 
troubles  of  the  movements  of  the  eyes 

You  have  just  seen  from  our  remarks  on  hysterical 
anesthesia  that  this  neurosis  may  disturb  the  sensorial 
as  well  as  the  motor  functions.  This  remark  is  ex- 
tremely important,  and  the  sensorial  disturbances  due 
to  hysteria  constitute  a  very  considerable  chapter  of 
pathology.  In  this  summary  review  of  the  great  symp- 
toms, we  cannot  follow  this  disease  into  the  domain  of 
each  perception.  Moreover,  what  will  be  said  about  a 
particular  sense  can  easily  enough  be  applied  to  all  the 
others. 

On  what  sense  must  we  particularly  insist?  What 
are  the  perceptions  on  which  hysteria  determines  quite 
typical  disturbances?  We  have  already  spoken  of  the 
tactile  sense.  Besides,  we  may  remark  that  disturbances 

182 


The  Troubles  of  Vision  183 

of  the  tactile  sense  are  not  quite  separate,  that  they 
are  nearly  always  connected  with  disturbances  of 
motion.  Remember  this  old  remark  of  a  French  doctor 
to  whom,  in  my  opinion,  justice  has  not  been  fully 
done,  Dr.  Burcq.  "Anesthesia,"  he  said,  "never 
exists  without  amyosthenia,  that  is  to  say  without  mus- 
cular weakness."  No  doubt,  in  certain  cases,  the  tactile 
perception  may  be  disturbed  only  as  perception  in  sub- 
jects who  need  their  tactile  sense  to  recognize  objects, 
but  this  occurs  seldom.  You  may  also  observe  dis- 
turbances of  tactile  localization,  particularly  the  sin- 
gular phenomenon  called  allochiria,  in  which  the 
patient  always  localizes  on  his  left  side  what  is  done  to 
him  on  his  right  side,  and  vice  versa.1 

Lastly,  you  may  connect  with  disturbances  of  the 
tactile  sense  certain  abnormal  pains  and  sensations,  but 
deliriums  always  enter  into  these  phenomena,  or  at 
least  associations  of  fixed  ideas.  No  more  do  I  insist 
on  the  senses  of  smell  and  taste.  They  are  very  often 
disturbed  in  hysteria,  but  scarcely  ever  so  in  an  inde- 
pendent way.  Their  disturbances  are  nearly  always 
associated  with  those  of  the  functions  of  alimentation 
and  breathing.  We  shall  find  them  again  when  we 
study  the  disturbances  of  the  visceral  functions. 

It  would  be  more  proper  to  devote  a  lecture  to  hys- 
terical deafness,  to  disturbances  of  hearing  in  these 
patients  which  are  often  associated  with  disturbances  of 
speech,  but  may  also  exist  separately.  Beware  of 
hysterical  deafness;  it  is  frequent  and,  if  I  mistake 

1  With  reference  to  this  problem,  see  the  chapter  on  Un  Cas 
<FAttochirie,  in  my  book  "  Nevroses  et  Id£es  fixes,"  1898,  p.  234. 


184      The   Major  Symptoms  of  Hysteria 

not,  occasions  very  numerous  errors  of  diagnosis.  To 
recognize  it,  with  reference  to  these  troubles  of  hearing 
I  am  glad  to  indicate  to  you  an  interesting  study  of 
Dr.  G.  L.  Walton :  "  Deafness  in  Hysterical  Anesthesia," 
published  in  The  Brain,  1883.  To  recognize  this  af- 
fection, remember  that  it  is  a  central  and  not  a  peripheric 
deafness.  Rinne's  well-known  experiment  will  give  you 
information  concerning  this  first  point.  When  the  deaf- 
ness is  peripheric,  when  it  is  due,  for  instance,  to  obstruc- 
tion of  the  canal,  to  a  disease  of  the  ossicles,  or  to  a  dis- 
turbance in  the  aeration  of  the  drum,  the  patient  keeps 
the  central  audition.  You  may  verify  it  by  making  him 
hear  a  watch  or  a  diapason  applied  to  his  teeth  or  to  the 
bones  of  his  skull.  The  vibrations  propagated  through 
the  bones  are  still  heard,  whereas  they  can  no  longer  be 
transmitted  by  the  air.  In  central  deafness  it  is  just 
the  reverse,  and  the  hysterical  disease  is  connected  with 
this  last  group.  This  being  once  established,  you  will 
be  able  to  make  the  diagnosis  by  studying  the  motile 
and  contradictory  character  of  this  anesthesia,  and  by 
examining  the  evolution.  I  regret  not  being  able  to 
insist  any  further  on  this  curious  symptom,  the  study 
of  which  is  now  beginning  to  be  in  fashion.  But  there 
is  a  sense  so  interesting  from  the  point  of  view  of 
hysteria,  and  the  alterations  of  which  are  so  characteris- 
tic for  the  comprehension  of  this  neurosis  that  I  want  to 
devote  to  it  as  much  time  as  possible,  and  it  is  the  rea- 
son why  our  study  on  the  hysterical  disturbances  of  the 
perceptions  must  be,  above  all,  a  study  on  the  diseases 
of  vision. 


The  Troubles  of  Vision  185 


You  know  now  the  general  idea  that  directs  us  in  the 
examination  of  the  innumerable  phenomena  of  hysteria ; 
it  is  the  idea  of  dissociation.  This  disease  seems  to  have 
an  analytic  power;  it  decomposes  the  enormous  "psy- 
cho-physiological system,  it  separates  its  functions. 
Nowhere  is  this  dissociation  more  precise  and  curious 
than  in  the  case  of  vision.  The  reason  is  that  vision  is 
a  very  complicated  function,  which  is  subdivided  into 
numerous  operations  and  which  plays  a  great  part  in 
the  mind.  Hysteria  can  effect  on  it  every  possible  dis- 
sociation. First,  it  may  separate  at  once  the  whole  of 
the  visual  function  from  the  ensemble  of  the  mind; 
this  is  the  most  radical  and  the  rarest  dissociation. 
Then  it  may  cause  the  visual  function  to  crumble,  so 
to  speak,  dividing  and  subdividing  it  into  its  elementary 
functions,  doing  away  with  one  and  sparing  another 
with  a  cleverness  that  the  greatest  physiologist  might 
envy.  You  even  see  here  an  example  of  the  services 
that  hysteria  may  render  to  the  physiologist  by  teaching 
him  in  what  way  composite  functions  are  decomposed, 
which  he  would  be  unable  to  analyze  himself. 

The  first  great  disturbance,  we  have  just  said,  is  the 
dissociation  of  the  ensemble  of  vision.  In  other  terms, 
it  is  hysterical  blindness.  This  phenomenon  is  rare,  for 
it  seems  that  the  subject  always  keeps  as  much  as  pos- 
sible the  essential  functions,  and  loses  only  a  part  of 
the  vision.  However,  the  fact  has  been  very  often 
established.  As  long  ago  as  1618,  Lepois  pointed  out 


1 86      The   Major  Symptoms  of  Hysteria 

this  blindness.  Since  then  it  has  been  studied  by  many 
authors,  and,  in  this  respect,  I  especially  draw  your 
attention  to  the  works  of  the  French  oculists,  such  as 
Landolt,  Borel,  and  Parinaud.  This  total  blindness 
comes  on  usually  in  consequence  of  accidents,  and  it 
belongs  to  the  phenomena  of  traumatic  hysteria. 

The  following  are  the  two  latest  cases  I  have  observed. 
A  man,  thirty-eight  years  old,  was  busy  cleaning  a 
machine.  A  rag  full  of  grease  and  petroleum  caught 
in  a  gear  and  lashed  him  on  the  face.  The  face  was 
only  dirtied,  and  he  did  not  trouble  about  the  accident. 
He  washed  himself,  but  he  had  much  difficulty  in  clear- 
ing his  skin  and  eyelids  of  these  fatty  substances.  Re- 
mark that  nothing  penetrated  into  his  eyes  and  that  he 
felt  no  pain  in  them.  However,  after  an  hour,  he  seemed 
to  see  as  it  were  a  mist  before  him ;  this  mist  grew  thicker 
and  two  hours  later  he  could  no  longer  see  at  all.  His 
vision  fluctuated  a  little  on  the  morrow  and  the  follow- 
ing days.  From  time  to  time  he  could  see  a  little, 
chiefly  with  his  right  eye.  These  fluctuations  lasted 
for  a  month,  then  they  disappeared  absolutely  and  for 
four  years  he  remained  quite  blind.  Here  is  a  woman, 
thirty-one  years  old,  whose  story  is  similar.  In  a  laun- 
dry where  she  worked  she  received  in  the  face  some 
water  mixed  with  soap  and  lime,  in  consequence  of  the 
explosion  of  a  boiler.  Her  skin  was  lightly  burnt  and 
her  eyelids  swelled.  She  was  in  her  menstrual  period 
when  the  accident  happened ;  she  felt  very  much  agi- 
tated and  very  giddy.  During  the  first  days  she  hardly 
dared  open  her  eyes;  it  was  soon  noticed  that  she 
could  see  no  more.  The  amaurosis  was  complete  for 


The  Troubles  of  Vision  187 

two  years.  When  I  examined  this  patient,  there  was 
already  a  slight  restoration  of  the  vision,  which  was 
easily  and  rapidly  completed.  In  other  cases,  the 
blindness  is  less  serious ;  it  lasts  a  few  days  and  disap- 
pears suddenly.  A  woman  of  twenty-seven  has  the 
following  singular  habit ;  while  reading,  she  sees,  as  it 
were,  a  red  flash  of  lightning  which  illuminates  the  room ; 
she  shuts  her  eyes  and,  when  she  opens  them  again, 
she  sees  no  more.  Once  this  accident  lasted  twelve 
days,  another  time  seven,  another  eight.  Her  sight 
comes  back  suddenly,  just  as  it  disappears. 

It  is  needless  to  tell  you  that,  when  the  blindness  is 
thus  complete,  the  diagnosis  is  very  difficult  and  that 
you  cannot  take  too  many  precautions.  Of  course 
you  must  first  ask  for  a  thorough  examination  of  the 
vision  made  by  a  competent  oculist.  You  should  beware 
of  lesions  of  the  fundus  of  the  eye  and  of  the  optic  nerve, 
of  hemorrhages  of  the  vitreous  body,  etc.  Inquire  into 
the  state  of  the  pupillary  reflexes.  Theoretically  they 
must  be  quite  normal  in  hysterical  blindness;  it  is  a 
rule  we  have  already  seen.  It  was  so  in  the  three  cases 
of  which  I  just  spoke  to  you.  It  is  true,  you  may  have 
complications  connected  with  the  contractures  of  the  iris, 
but  then  do  not  be  in  too  great  a  hurry  to  make  a  diag- 
nosis. Of  course  you  will  find  a  great  help  in  the  study 
of  the  mobility  of  the  phenomenon,  if  you  can  provoke 
it.  Sometimes  this  kind  of  blindness  disappears  ab- 
solutely in  abnormal  states,  in  crises  or  in  somnambu- 
lisms; then  it  is  all  right.  Lastly,  you  will  sometimes 
succeed  in  making  the  contradictory  character  evident 
and  in  showing  that,  in  reality,  the  hysterical  can  see, 


1 88      The  Major  Symptoms  of  Hysteria 

though  she  maintains  the  contrary.  Professor  Jolly, 
of  Berlin,  said  in  this  respect:  "Those  children,  who 
seem  not  to  perceive  any  light,  nevertheless  avoid  ob- 
stacles unexpectedly  put  before  them ;  they  do  not  be- 
have like  people  really  blind,  they  must  have  a  kind  of 
perception."  l  You  recognize  in  this  our  subconscious 
perception,  the  establishment  of  which  assumes  great 
importance  here.  It  is  however,  true  that  complete, 
hysterical  blindness,  which  happily  is  rare,  is  always 
very  perplexing  to  physicians. 

Happily  it  is  no  longer  so,  when  we  consider  the  in- 
complete and  more  frequent  forms  into  which  hysteria 
decomposes  the  visual  function,  doing  away  with  only 
one  part  of  it.  The  simplest  and,  if  I  may  say  so,  the 
most  amusing  of  these  decompositions  is  unilateral 
amaurosis,  which  is  simply  grounded  on  the  fact  that 
man  has  two  eyes  and  that  total  vision  is  a  system  com- 
posed of  two  visions.  Very  often  you  hear  young  people 
complaining  that  they  see  only  with  one  eye.  They 
do  not  trouble  very  much,  however,  about  this  accident ; 
usually,  they  do  not  know  its  origin  and  have  noticed 
it  by  chance.  Being  one  day  obliged,  for  some  reason, 
to  keep  their  right  eye  shut,  they  are  quite  surprised  to 
find  themselves  in  darkness.  You  repeat  the  experiment, 
and  you  recognize  that  they  see  quite  well  when  they 
have  both  their  eyes  open,  but  see  absolutely  nothing 
when  one  of  their  eyes  is  shut.  These  observations 
are  innumerable  and  they  have  given  rise  to  many 
studies  and  discussions  about  hysteria.  It  is  perhaps 

1  F.  Jolly,  "  Ueber  Hysteria  bei  Kindern,"  Berliner  Klin.  Wochen- 
schr.,  1892,  No.  34,  p.  4. 


The  Troubles  of  Vision  189 

one  of  the  facts  which  served  as  introduction  to  the 
studies  of  experimental  psychology. 

The  reason  is  that  this  amaurosis  presented  itself 
in  rather  odd  conditions  and  was  for  oculists  an  irritat- 
ing problem.  Why?  There  is  nothing  extraordinary 
in  the  fact  that  an  eye  is  affected  separately.  It  is 
because  we  find  here,  carried  to  the  highest  degree, 
the  character  of  hysterical  anesthesia.  First  this 
blindness  occurs  without  any  appreciable  organic  dis- 
turbance and  without  any  impairment  of  the  elementary 
function  of  the  organ.  The  eye  is  absolutely  uninjured 
outwardly  and  inwardly;  its  important  reflexes  are 
quite  unimpaired.  However  you  may,  not  infrequently, 
recognize  a  suppression  of  the  reflexes  of  peripheric 
origin;  I  mean  the  corneal  and  conjunctival  reflexes. 
The  touching  of  the  conjunctiva  or  of  the  cornea  with 
a  bit  of  paper,  for  instance,  will  not  bring  on  the  spas- 
modic shutting  of  the  eyelids.  We  have  there  a  reflex 
of  superficial  sensibility  which  may  be  disturbed.  But 
the  pupillary  reflexes  to  light  and  to  accommodation 
are  mostly  perfect,  with  a  reservation  of  contractures 
of  the  iris,  of  which  I  told  you  to  beware.  In  these 
conditions  physicians  are  astonished  that  the  subject 
cannot  see. 

In  certain  particular  cases,  their  distrust  is  still  more 
justifiable,  as  when,  for  instance,  before  the  board  of 
examination  for  recruits,  young  men,  wishing  to  avoid 
military  service,  maintain  that  they  are  blind  of  the 
right  eye  and  that  they  are  unable  to  take  aim.  The 
army  surgeon  charged  with  the  inspection  has  certainly 
a  right  to  express  some  doubt,  when  he  does  not  recog- 


190     The  Major  Symptoms  of  Hysteria 

nize  any  objective  disturbance  in  this  eye  and  sees  the 
pupil  react  to  light  as  if  the  retina  perceived  quite  well. 
He  invents  subtle  processes  to  find  out  what  he  thinks 
is  a  fraud.  The  two  prettiest  of  those  processes  are 
the  letters  of  Snellen  and  the  box  of  Flees.  On  an  ab- 
solutely dark  ground  are  pasted  letters  cut  out  of  paper, 
some  blue,  others  red.  To  the  eyes  of  the  subject  is 
applied  a  pair  of  eye-glasses,  one  of  the  glasses  of  which 
is  quite  of  the  same  blue  tint  as  the  letters,  and  the  other 
of  the  same  red  tint.  Through  the  red  glass,  which  lets 
only  the  red  rays  pass  through,  the  red  letters  on  the 
black  ground  can  be  seen,  but  the  blue  ones  become  as 
black  as  the  ground  and  cannot  be  distinguished  from  it ; 
while  the  reverse  is  true  for  the  blue  glass.  The  result 
is  that,  in  these  conditions,  the  right  eye  can  read  only 
one-half  of  the  letters  and  the  left  eye  the  other  half. 
A  person  who  sees  with  both  eyes  instinctively  com- 
pletes one  eye  with  the  other  and  reads  the  whole  word 
without  difficulty.  In  these  conditions,  a  one-eyed 
person  can  only  read  a  part  of  the  letters.  Now  what 
does  our  recruit  do  ?  With  the  eye-glasses  on  his  eyes, 
he  quietly  reads  all  the  letters  on  the  black  board. 

The  box  of  Flees  is  still  more  ingenious.  Here 
(Figure  12)  is  its  schema:  the  subject  looks  into  a  little 
box  through  two  holes  corresponding  to  his  two  eyes, 
D  and  G.  At  each  end  of  the  box  are  two  coloured 
spots,  two  wafers,  one  red,  R,  and  the  other  white,  B, 
for  instance.  But  the  subject  cannot  see  them  directly, 
he  only  sees  their  images  in  two  little  mirrors,  MM,  hidden 
in  the  bottom  of  the  box  in  black  paper  and  making  an 
angle  of  45  degrees  with  the  bottom.  These  mirrors 


The  Troubles  of  Vision 


191 


cast  the  images  of  the  wafers  sideways,  in  a  strange  way ; 
the  object,  which  in  reality  is  seen  by  the  right  eye,  D, 
appears  on  the  left  side  in  B,  and  the  object,  which  in 
reality  is  seen  by  the  left  eye,  G,  appears  on  the  right 


FIG.  12.  —  Schema  of  the  box  of  Flees. 

side  in  R.  Neither,  however,  of  those  wafers  can  be  seen 
simultaneously  by  the  two  eyes.  How  would  a  one- 
eyed  man,  who  has  really  lost  his  left  eye,  conduct  him- 
self when  asked  to  look  into  this  box  ?  He  would  say : 
"I  see  only  one  wafer,  the  white  one,  B,  for  instance, 
but  what  astonishes  me  is  that  it  appears  on  my  left 
side ;  now  usually,  I  am  not  able  to  see  on  this  side." 


192      The   Major  Symptoms  of  Hysteria 

What  will  a  malingerer  do  who  sees  with  his  left  eye 
but  pretends  to  be  blind  of  this  eye  ?  In  reality  he  will 
see  the  two  wafers,  but  as  he  will  think  it  necessary  to 
suppress  one,  he  will  of  course  suppress  the  one  which 
appears  on  the  left  side,  the  supposed  blind  side;  he 
suppresses  the  white  wafer,  B,  and  he  declares  that  he 
sees  only  one  wafer,  the  red  one  on  his  right  side. 
Now  as  this  wafer,  R,  can  only  be  seen  by  the  left  eye, 
which  he  pretends  is  blind,  the -fraud  is  discovered. 

How  do  our  hysterical  patients  conduct  themselves 
in  presence  of  this  box  ?  We  must  admit  that  they  look 
very  absurd :  Oftenest  they  naively  say  that  they  see 
both  wafers.  You  will  understand  that  formerly,  in 
these  conditions,  they  were  generally  accused  of  fraud. 
It  is  strange  to  remark  that  our  hystericals  are  not  lucky ; 
their  accidents  are  such  that  they  are  nearly  always 
mistaken  for  crimes  or  tricks.  Some  were  burnt  on 
account  of  their  fits  or  devil's  claws,  others  were  sent  to 
prison  in  order  to  be  cured  of  their  amaurosis. 

However  it  may  be,  these  singular  facts  discovered  by 
army  surgeons  had  excited  curiosity :  there  was  a  time, 
especially  in  France,  when  the  apparently  insignificant 
little  phenomenon  of  unilateral  amaurosis  was  intensely 
studied.  With  the  researches  of  that  period  are  con- 
nected the  names  of  Regnard,  Parinaud,  Bernheim,  and 
perhaps  also  mine,  if  you  will  allow  me  to  recall  it.  To 
the  preceding  experiments  many  others  of  much  the 
same  kind  have  been  added.  You  know  the  old  ex- 
periment of  the  physicist  Brewster :  if  the  subject  looks 
at  an  object  with  both  eyes  open  and  if  you  press  slightly 
on  one  of  his  eyes,  he  sees  two  objects  instead  of  one, 


The  Troubles  of  Vision  193 

simply  because  the  object  is  no  longer  painted  on  the 
concording  points  of  the  two  retinas.  If,  in  the  same 
conditions,  without  touching  the  eyes  you  put  a  prism 
before  one  eye,  the  same  phenomenon  takes  place, 
the  object  is  doubled.  Of  course  this  doubling  im- 
plies the  existence  of  two  eyes  and  two  visions ;  nothing 
of  the  kind  takes  place  if  the  experiment  is  repeated  with 
a  one-eyed  person.  You  can  verify  it  yourself  by  shut- 
ting one  eye  and  slightly  pressing  on  the  other ;  the  ob- 
ject moves,  but  is  not  doubled.  Well,  in  the  unilateral 
amaurosis  of  hystericals,  all  these  experiments  and  many 
others  of  the  same  kind  give  the  same  results  as  with 
normal  subjects  who  see  with  both  eyes. 

The  explanation  based  on  fraud  is  very  simple,  per- 
haps too  simple  in  the  case  of  persons  who  are  not 
recruits  and  have  not  the  least  interest  in  giving  them- 
selves out  to  be  one-eyed,  and  must  even  pay  the  oculist 
when  they  take  advice.  With  a  more  attentive  obser- 
vation this  first  interpretation  of  things  was  given  up. 
We  have  all  recorded  our  word  on  this  question.  Of 
course  M.  Bernheim  spoke  of  suggestion.  I  have  my- 
self insisted  on  the  subconscious  sensations,  which  con- 
tinue to  exist  in  certain  cases,  though  the  subject  has 
no  personal  perception  of  them.  But  now  I  acknowl- 
edge that  M.  Parinaud  has  given  the  best  formula  of 
this  special  fact.  In  a  pretty  disquisition  on  vision  he 
showed  that  the  existence  of  the  two  eyes  and  their 
position  gave  birth  to  two  different  visions.  First,  there 
is  the  monocular  vision,  either  separate  or  alternating, 
which  is  the  only  one  with  many  animals,  as  horses, 
whose  eyes  are  on  either  side  of  the  head.  They  can 


194      The  Major  Symptoms  of  Hysteria 

look  to  the  right  or  to  the  left,  they  can  alternate,  but 
that  is  all.  With  animals  such  as  man,  monkeys,  and 
some  dogs,  whose  two  eyes  are  nearly  on  the  same  plane, 
things  are  more  complicated.  These  beings  may 
have  not  only  the  preceding  monocular  and  alternating 
vision,  but  also  another  vision  called  the  binocular 
vision.  This  vision  consists  in  the  synthesis  of  the  two 
preceding  ones,  which  enables  us  to  see  only  one  object 
with  two  eyes.  This  vision  is  an  improvement  on  the 
preceding  one,  in  that  it  allows  us  to  see  the  same  ob- 
ject more  clearly,  permits  fixity,  and  gives  the  appearance 
of  relief.  It  is  the  starting  point  of  the  experiment  with 
the  stereoscope.  Generally  we  make  use  of  this  vision, 
but  we  retain  the  possibility  of  using  the  inferior  vision, 
which  we  utilize  in  many  cases,  sometimes  involuntarily 
to  see  sideways,  or  when  one  eye  is  tired,  sometimes 
voluntarily  by  shutting  one  eye  when  taking  aim  with  a 
pistol  or  looking  in  a  microscope. 

Now  it  is  very  curious  to  see  that  hystericals  are  able  to 
effect  the  dissociation  of  these  two  visions,  the  existence 
of  which  we  scarcely  suspected.  They  mostly  lose  — 
and  this  is  an  accident  that  was  not  known  —  they 
lose  the  binocular  vision,  that  is  to  say  the  higher,  truly 
human  vision.  Only  they  do  not  complain  of  it;  it 
is  the  medical  examination  that  will  reveal  to  you  this 
unexpected  thing,  that  an  hysterical  cannot  look  with 
a  stereoscope  and  is  unable  to  perceive  the  relief  in 
Ducos  de  Hauron's  anaglyphs.  But  sometimes  also 
they  lose  the  monocular  vision  of  one  eye  while  keeping 
the  binocular  vision.  The  preceding  experiments,  by 
appealing  to  the  binocular  vision,  by  making  it  neces- 


The  Troubles  of  Vision  195 

sary,  placed  hystericals  in  conditions  in  which  their 
disturbances  did  not  appear.  You  see  that  this  sin- 
gular amaurosis  has  already  dissociated  the  visual  func- 
tion in  an  amusing  manner,  setting  apart  now  the  binocu- 
lar, now  the  monocular  function. 

II 

Let  us  continue  the  examination  of  the  hysterical  disT 
turbances  of  vision  and  we  shall  see  that  dissociation 
will  still  gain  ground  and  enter  into  more  delicate  func- 
tions. The  most  important  symptom  to  be  known  now 
is  the  famous  narrowing  of  the  visual  field  on  which 
we  ought  to  be  able  to  dwell  for  a  long  time.  You  know 
that  human  sight,  owing  to  the  dimensions  of  the  retina, 
extends  over  a  certain  surface.  The  extent  of  the  sur- 
face an  eye  can  see  simultaneously,  without  moving, 
is  called  the  visual  field.  No  doubt  all  the  points  of 
this  definition  should  be  discussed.  It  is  not  quite  cer- 
tain, in  particular,  that  all  the  points  of  the  visual  field 
are  seen  simultaneously  in  a  single  act  of  attention; 
but  this  definition  is  practically  sufficient.  If  you 
measure  the  visual  field  of  a  normal  subject  with  those 
instruments  which  are  called  campimeters  and  perim- 
eters, the  description  of  which  would  be  too  long,  you 
obtain  the  following  figure,  which  I  have  presented  to 
you  in  this  picture  of  the  visual  field  of  the  right  eye, 
R,  in  Figure  13.  The  field  has  the  form  of  an  irregular 
circle,  more  extended  on  the  external  and  on  the  in- 
ferior sides,  where  it  measures  almost  90°,  which  means 
that  the  angles  formed  by  the  fixation  point,  the  eye 


The  Troubles  of  Vision  197 

for  vertex,  and  the  limit  of  the  visual  field,  is  of  90°. 
The  circle  is  narrowed  on  the  internal  and  superior 
sides,  where  it  is  barely  60° ;  this  very  natural  diminu- 
tion is  due,  as  you  may  guess,  to  the  obstacle  formed 
by  the  nose  and  the  eyebrows. 

Well,  if  you  examine  the  visual  field  of  hystericals, 
you  will  recognize  a  very  remarkable  fact,  which  very 
likely  exists  only  in  this  neurosis;  the  visual  field  is 
narrowed  concentrically.  The  extent  of  the  simul- 
taneous vision  becomes  smaller;  the  field  is  almost 
circular  at  30°  or  20°,  as  you  see  in  the  left  eye  of  the 
figure  13.  Sometimes  the  field  has  only  10°  or  5°, 
and  nothing  is  left  but  the  fixation  point.  It  is  true  that 
a  disease  of  the  retina,  pigmentary  retinitis,  and  perhaps 
also  certain  forms  of  chronic  glaucoma,  give  rise  to  an 
analogous  phenomenon,  but  then,  in  the  first  place,  the 
visual  field  has  an  irregular  form,  and,  in  the  second 
place,  there  are  visible  lesions  of  the  fundus  of  the  eye. 
As  regards  the  diseases  of  the  nervous  system,  it  has 
been  said  that  this  concentric  contraction  of  the  visual 
field  is  found  in  epilepsy  and  in  disseminated  sclerosis. 
This  has  been  recognized  to  be  false ;  so  this  symptom 
becomes  one  of  the  most  important  of  hysteria,  not  for 
the  patient  of  course,  but  for  the  physician  who  makes 
use  of  it  as  a  characteristic  sign. 

This  contraction  of  the  visual  field  has  interesting 
psychological  properties ;  it  is  quite  a  matter  of  indiffer- 
ence to  the  subject,  and  this  is  a  curious  fact,  on  which  I 
have  elsewhere  insisted.1  As  a  matter  of  fact  nothing  is 

1  "  The  Mental  State  of  Hystericals,"  translation   into  English, 


198      The  Major  Symptoms  of  Hysteria 

so  inconvenient  as  a  real  contraction  of  the  visual  field ; 
you  know  how  the  unfortunate  people  who  are  affected 
with  chronic  glaucoma  complain  of  being  no  longer  able 
to  glance  over  their  newspaper  because  they  see  only 
one  word  or  one  syllable  at  a  time.  These  patients,  who, 
however,  see  very  well  in  the  centre,  can  no  longer  find 
their  way  in  the  street.  Hystericals,  who  have  an  ex- 
ceedingly small  visual  field,  run  without  in  the  least 
troubling  themselves  about  it.  This  is  a  curious  fact 
to  which  I  remember  having  attracted  the  attention  of 
Charcot,  who,  had  not  remarked  it,  and  was  very  much 
surprised  at  it.  I  showed  him  two  of  our  young  patients 
playing  very  cleverly  at  ball  in  the  courtyard  of  La 
Salpetriere.  Then,  having  brought  them  before  him, 
I  remarked  to  him  that  their  visual  field  was  reduced 
to  a  point,  and  I  asked  him  whether  he  would  be  capa- 
ble of  playing  at  ball,  if  he  had  before  each  eye  a  card 
merely  pierced  with  a  small  hole.  It  is  one  of  the  finest 
examples  that  can  be  shown  of  the  persistence  of  sub- 
conscious sensations  in  hysteria. 

Besides,  I  had  shortly  afterwards  the  opportunity 
of  making  a  still  more  precise  experiment  on  the  same 
point.  A  young  boy  had  violent  crises  of  terror  caused 
by  a  fire,  and  it  was  enough  to  show  him  a  small  flame 
for  the  fit  to  begin  again.  Now  his  visual  field  was 
reduced  to  5°  and  he  seemed  to  see  absolutely  nothing 
outside  of  it.  I  showed  that  I  could  provoke  his  fit  by 
merely  making  him  fix  his  eyes  on  the  central  point  of 
the  perimeter  and  then  approaching  a  lighted  match 
to  the  eightieth  degree.  The  same  experiment  can  be 
more  simply  realized  by  using  suggestions,  of  which 


The  Troubles  of  Vision  199 

we  shall  speak  later.  A  subject  has  received  the  order, 
which  he  obeys  unconsciously,  to  raise  his  arm  as  soon 
as  he  sees  a  paper  before  his  eyes.  The  suggestion  is 
executed  even  if  the  paper  is  put  at  the  eightieth  degree, 
far  out  of  the  limits  of  his  conscious  visual  field.  You 
see  that  this  hysterical  disturbance  has  not  quite  done 
away  with  ocular  perception  in  the  lateral  parts  of  the 
retina.  It  is  again  a  dissociation  like  the  preceding 
ones.  We  have  two  visions,  the  central  vision,  which  is 
accurate  and  attentive,  and  the  peripheric  vision,  which 
is  vacant  and  of  secondary  importance.  You  see  that 
the  hysterical  keeps  only  the  first  consciously,  the  second 
persisting  quite  subconsciously. 

I  cannot  end  this  examination  of  the  visual  field 
without  saying  a  few  words  on'  a  very  curious  problem 
in  which  I  took  a  particular  interest.  Can  the  visual 
field  be  modified  only  in  this  way?  In  other  words,  is 
the  contraction  always  concentric?  We  have  not  the 
time  to  examine  the  different  faces  of  this  problem. 
I  shall  only  insist  on  one.  Can  we  meet  in  hysteria  with 
the  hemiopical  visual  field  or  with  the  phenomenon  of 
hemianopsia?  The  question  is  more  important  than 
it  looks.  Hemianopsia,  that  is  to  say  the  vision  of  only 
one-half  of  the  visual  field,  is  a  frequent  phenomenon, 
often  succeeding  cerebral  lesions.  The  section  of  the 
optical  nerves,  Gratiolet's  radiations,  the  lesions  of  the 
occipital  lobes,  of  the  cuneus,  do  away  with  the  vision 
in  one  of  the  vertical  halves  of  the  retina,  and  you  know 
that  the  lesion  is  distinguished  by  the  place  and  form 
of  this  hemianopsia.  After  some  fluctuations,  physi- 
cians had  come,  especially  after  Gilles  de  la  Tourette's 


2OO      The  Major  Symptoms  of  Hysteria 

work,  to  deny  absolutely  the  existence  of  hysterical 
hemianopsia,  and  to  reserve  this  symptom  for  organic 
lesions.  This  decision  is  not  tenable  a  priori.  I  do  not 
see  any  reason  why  the  functional  disturbance  of 
hysteria  should  not  realize  the  same  symptoms  as  the 
organic  destruction  of  the  centre  of  the  function. 
Every  function,  as  we  said  when  treating  of  paralyses, 
finally  has,  when  it  is  old,  its  organic  centre,  and,  in 
certain  cases,  the  functional  and  organic  disturbances 
may  be  alike.  Besides,  did  we  not  unquestionably 
establish  this  fact  when  we  studied  hemiplegy?  There 
is  no  disturbance  more  symptomatic  of  a  great  lesion 
than  motor  hemiplegy,  and  nobody  denies  that  it  takes 
place  in  hysteria.  It  is  the  same  with  hemianopsia, 
and,  in  despite  of  theories,  we  must  recognize  a  fact  if 
it  exists. 

After  the  preceding  period  of  negation,  M.  De"jerine 
in  1894  and  I  myself  in  1895  presented  the  first  authentic 
observations  of  functional  hemianopsia.1  I  think  I 
gave  the  demonstration  of  the  hysterical  character  of 
this  syndrome  by  showing  the  existence  of  subconscious 
sensations  in  the  apparently  suppressed  part  of  the  visual 
field  (Figure  14).  Since  then  I  have  had  the  opportunity 
to  show  other  equally  distinct  cases,  a  schema  of  which 
you  see  here  (Figure  15).  In  a  paper  which  appeared 
in  The  Brain  in  1897,  W.  Harris  presented  analogous 
cases:2  he  pointed  out,  in  particular,  as  I  had  done 

1  "  Un  Cas  d'Hemianopsie  Hystfrique,"  Lecture  at  the  Salpetriere, 
on  January  25,  1895,  Archives  de  Neurologic,  May,  1895,  p.  339,  and 
in  "  N6vroses  et  Idees  fixes,"  I,  p.  263. 

2  Wilfred  Harris,  "  Hemianopsia  with   Special   Reference  to  its 
Transient  Variations,"  The  Brain,  1897,  p.  308. 


The  Troubles  of  Vision  201 

myself,  some  cases  in  which  hysterical  hemianopsia 
begins  with  amaurosis.  It  is  at  the  time  of  the  recovery 
from  an  hysterical  amaurosis  that  the  visual  field  takes 
in  many  cases  the  hemianopsic  form  for  some  time.  I 
refer  you,  with  respect  to  this,  to  my  paper  on  transi- 
tory hemianopsia.1 

These  phenomena  of  hemianopsia  should  not,  I 
think,  astonish  us  beyond  all  measure,  and  induce 
us  to  transform  our  general  conception  of  the  neu- 
rosis. The  study  of  the  anatomical  localization  of  the 
vision  leads  us  to  conceive  a  particular  distribution  of 
vision  on  the  retina.  Suppose  a  man  having  only 
one  eye,  in  the  middle  of  his  forehead,  like  the  Cyclops, 
or  if  you  prefer  it,  two  eyes  placed  one  under  the 
other  in  the  middle  of  his  head.  Each  of  these  eyes 
will  have  a  right  half  and  a  left  half  like  the  rest  of  the 
body,  and  a  distinct  function  of  the  vision  to  the  right 
and  of  the  vision  to  the  left  will  form,  comprising  the 
two  right  halves  and  the  two  left  halves  of  the  two  eyes. 
Later  the  two  eyes  separated  and  disposed  themselves 
otherwise,  but  the  function  has  remained  the  same  and 
there  is  still  now  a  function  of  the  vision  to  the  right  and 
another  of  the  vision  to  the  left.  These  functions  may 
become  dissociated  in  hysteria  just  as  all  the  others; 
only,  as  these  functions  are  very  old,  the  dissociation 
seldom  goes  so  far.  It  exists  sometimes  however, 
and  hysterical  hemianopsia  is  a  profound  accident 
which  can  be  compared  to  motor  hemiplegy. 

1  "  Un  Cas  d'Hemianopsie  Hystdrique  Transitoire,"  La  Prase 
M&dicale,  October  25,  1899,  p.  241. 


I 


3 

.9 


1 


204     The  Major  Symptoms  of  Hysteria 


111 

You  can  now  apply  the  same  method  yourselves  to 
the  interpretation  of  all  the  other  visual  disturbances, 
which  are  still  very  numerous.  I  will  only  point  out 
to  you  dyschromatopsia,  that  is  to. say,  the  loss  of  the* 
vision  of  colours.  It  frequently  happens  that  hystericals, 
while  still  having  a  good  visual  acuity,  cease  to  perceive 
colours,  or  at  least  certain  colours.  Violet,  blue,  and 
green  seem  to  vanish  first. 

Red  appears  to  be  the  most  persistent  colour.  This 
fact  was  formerly  considered  as  accounting  for  the 
fondness- of  hystericals  for  red.  They  are  fond  of 
dressing  in  showy  colours,  of  putting  red  ribbons  in  their 
hair.  The  reason  is,  it  was  said,  that  these  colours 
are  the  only  ones  they  continue  to  see.  There  is  some 
exaggeration  in  this,  and  it  is  more  likely  that  moral 
reasons,  such  as  the  very  curious  need  they  feel  to  be 
noticed,  play  a  more  considerable  part  in  this  phe- 
nomenon. 

I  think  also  that  this  loss  of  colours  has  been  examined 
with  exaggerated  accuracy;  a  visual  field  of  colours 
has  been  drawn,  and  efforts  have  been  made  to  prove 
that  in  hysteria  this  visual  field  is  modified  in  a  regular 
manner,  the  visual  field  of  blue,  for  instance,  becoming 
in  this  disease  smaller  than  that  of  red.  It  may  be  so, 
but  I  advise  you  to  be  cautious  in  this  study.  First 
of  all,  the  perception  of  colours  at  the  periphery  of  the 
visual  field  changes  very  much,  even  in  a  normal 
person,  according  to  all  kinds  of  conditions  and,  in 


The  Troubles  of  Vision  205 

particular,  according  to  the  lighting.  Besides,  in 
hystericals,  the  influence  of  the  association  of  ideas 
plays  an  enormous  part  in  the  perception  of  colours. 
A  young  woman  saw  red  flowers  put  on  her  father's 
coffin.  It  made  her  very  angry,  because  these  flowers 
constituted  a  political  emblem;  she  now  holds  red  in 
abhorrence,  and  has  on  that  account  a  very  fine  percep- 
tion of  red  and  a  visual  field  for  red  more  extended  than 
for  white.  Special  account  should  be  taken  of  the  part 
played  by  perceptions  and  ideas  in  the  dissociation  of 
the  small  details  of  vision,  particularly  in  the  accidents 
of  painful  vision,  of  fears  of  certain  colours,  of  photo- 
phobia, which  I  merely  point  out  to  you. 

I  wish  to  insist,  before  ending  this  lesson,  on  some 
other  accidents,  the  types  of  which  I  must  at  least  in- 
dicate to  you.  These  accidents  are  the  disturbances  in 
the  motion  of  the  eyes,  about  which  you  will  notice  as 
many  complications  as  about  vision  itself.  Let  us  not 
speak  of  the  movements  of  the  eyelids ;  you  will  again 
find  here  the  phenomena  of  paralysis,  tics,  contractures, 
which  we  have  already  studied. 

But  let  us  dwell  a  little  on  ophthalmoplegy,  such  as 
was  pointed  out  by  Lebreton,  Ballet,  Bristow,  and 
especially  by  Koenig  in  1891,  because  it  is  again  an 
interesting  phenomenon  as  regards  interpretation. 
Certain  subjects  seem  to  become  unable  to  move  their 
eyes;  they  have  an  absolutely  fixed  look  which  seems 
strange.  Such  fixity  of  the  look  is  often  connected 
with  an  automatic  fixation  of  certain  objects  or  with 
certain  hallucinations.  This  is  the  most  frequent  case, 
and  when  one  can  divert  the  subject  from  his  fixed  idea, 


206      The  Major  Symptoms  of  Hysteria 

he  looks  in  every  direction.  But  in  certain  cases,  which 
have  as  yet  been  rather  seldom  described,  it  is  not  so. 
The  subject  looks  at  nothing  fixedly;  he  can  look  at 
different  objects,  but  only  by  turning  his  head;  it  is 
his  eyes  that  do  not  move.  Earlier  authors,  among 
them  Morax  and  Parinaud,  showed  that  this  immobility 
is  purely  in  connection  with  the  will.  If  the  subject 
wants  to  look  sideways,  if  he  is  asked  to  do  so,  if  he 
thinks  of  it,  he  cannot  manage  it ;  but  do  not  think  it 
is  an  absolute  immobility,  it  is  sufficient  to  let  an  object 
fall  noisily  near  him  without  warning  him,  and  his  eyes 
will  immediately  and  rapidly  turn  in  this  direction.  In 
a  word,  here  as  always,  the  subconscious  and  automatic 
motion  is  retained,  whereas  the  voluntary  motion  is  lost. 
These  disturbances  of  the  movements  of  the  ocular 
muscles  may  be  less  simple  and  consist  in  spasms,  in 
irregular  contractures.  Then,  of  course,  the  eyes  will 
deviate  in  one  direction  or  the  other,  and  you  will  have 
all  possible  forms  of  strabismus,  the  diagnosis  of  which 
is  also  important.  Lastly  the  disturbance  of  the  ocular 
motion  may  affect  the  internal  muscles,  and  particu- 
larly the  muscles  of  the  crystalline  lens.  Here  again, 
we  have  a  function  that  becomes  dissociated,  that  of 
accommodation.  Instead  of  being  able  to  accommodate 
their  eyes  to  very  various  distances,  from  thirty  centi- 
meters to  the  horizon,  these  patients  have  only  a  very 
limited  accommodation.  Their  eyes  are  an  optical  in- 
strument in  crystal  adjusted  to  a  given  and  immutable 
distance.  When  you  find  the  exact  distance  to  which 
they  are  accommodated,  fifty  centimeters  for  instance, 
or  one  meter,  an  object  placed  at  this  distance  is  seen 


The  Troubles  of  Vision  207 

quite  clearly,  but  it  is  no  longer  seen  at  all  if  you  put  it 
nearer  or  farther.  This  spasm  of  accommodation  is  con- 
nected with  a  great  many  hysterical  disturbances  on 
which  I  am  very  sorry  not  to  be  able  to  dwell :  monoc- 
ular diplopy,  polyopy,  macropsia,  micropsia,  etc.  Now 
objects  are  seen  double,  or  triple,  and  that  by  a  single 
eye,  which,  from  the  point  of  view  of  optics,  seems 
quite  paradoxical.  Now  they  are  seen  too  large  or  too 
small  or  deformed  in  a  thousand  ways.  I  have  de- 
scribed in  this  connection  some  very  odd  phenomena : 1 
objects  appearing  to  the  subject  too  big  or  too  small  in 
one  of  their  halves  only,  and  quite  normal  in  the  other 
—  a  kind  of  hemimacropsia. 

I  shall  only  point  out  to  you,  if  not  two  theses,  at 
least  two  tendencies  in  the  interpretation  of  these  odd 
phenomena.  M.  Parinaud  and  his  school  sought  a 
physical  interpretation  of  the  accidents  in  the  contrac- 
ture  of  the  crystalline  lens;  others  attribute  a  more 
important  part  to  psychological  phenomena.  You  have 
here  a  fine  field  open  to  your  personal  researches.  You 
see  what  would  be  the  richness  of  a  study  that  bears 
upon  the  hysterical  disturbances  of  visual  perceptions. 

Let  us  only  retain  the  two  following  general  notions : 
First,  the  disturbance  is  never  very  profound,  and  al- 
ways bears  solely  on  attentive  and  voluntary  perceptions. 
It  always  spares  the  elementary  sensations,  reflexes, 
anatomical  movements.  Second,  the  disturbance  seems 
to  consist  in  a  very  curious  separation  of  the  different 
functions  united  in  the  vision,  which  all  at  the  same  time, 
or  each  in  its  turn,  separate  from  personal  consciousness 
and  seem  to  proceed  henceforward  on  their  own  account. 

1  N^vroses  et  Id£es  fixes,"  I,  p.  276. 


LECTURE  X 
THE  TROUBLES   OF  SPEECH 

Importance  of  the  psychological  study  0}  the  disturbances  of 
speech  —  Description  of  some  cases  of  hysterical  mutism  — 
The  part  played  by  emotion,  by  shocks  on  the  right  side 

—  The  characters  of  hysterical  dumbness  —  The  for  get- 
fulness  of  speech  —  The  absence  of  paralytic  phenomena 

—  The  alleged  differences  between  hysterical  mutisms  and 
organic  aphasias  —  The  different  forms  of  hysterical  dumb- 
ness—  Aphonia  —  Stammering  —  Aphemia  —  Agraphia 

—  A  case  of  hysterical  word-deafness  —  Automatic  speech 
during   hysterical  mutism  or  alternating  with  periods  of 
dumbness  —  Tics  or  agitations  of  speech  —  The  emancipa- 
tion of  the  function  of  speech 

As  we  now  know  the  disturbances  of  motion  and  those 
of  perceptions,  we  can  enter  upon  the  study  of  a  complex 
phenomenon,  which,  in  reality,  is  nothing  but  a  mixture 
of  the  preceding  symptoms ;  I  mean  the  disturbances  of 
speech.  The  function  of  speech  plays  a  considerable 
part  in  every  impairment  of  thought;  it  is  always 
more  or  less  modified  in  all  intellectual  disturbances. 
However,  most  mental  derangements  bear  upon  a  some- 
what higher  level,  upon  the  formation  of  ideas  properly 
so  called.  On  the  contrary,  hysteria,  which  bears 
essentially  upon  the  voluntary  functions  of  motion,  upon 
the  conscious  perceptions,  reaches  precisely  this  mental 

208 


The  Troubles  of  Speech  209 

level  to  which  speech  corresponds,  and  must  determine 
very  frequent  disturbances  in  the  expression  of  thoughts. 
These  disturbances  have  long  been  known,  but  phy- 
sicians have  generally  been  inclined  to  consider  them 
as  being  of  quite  a  particular  nature.  They  thought 
that  hysterical  phenomena  could  not  be  like  others, 
and  it  seems  to  me  that  they  separated  far  too  much  the 
disturbances  of  speech  in  hystericals  from  the  pathology 
of  speech  in  general.  I  should  like  to  show  you  that  all 
the  disturbances  of  speech,  whatever  they  may  be,  are 
to  be  found  in  these  patients,  and  that  you  can  study  the 
pathology  of  aphasia  in  them  as  well  as  in  organic 
patients,  and  even  better.  Now,  when  in  the  papers  of 
Dr.  Pierre  Marie  of  Paris  the  troubles  of  aphasia  are 
brought  nearer  the  disturbances  of  thought,1  it  is  in- 
teresting to  study  the  hysterical  troubles  of  speech  in 
which  the  alteration  of  the  whole  consciousness  is  more 
evident. 

I 

In  antiquity  certain  impairments  of  speech  had  al- 
ready been  noticed,  the  rapid  evolution  and  the  surpris- 
ing cure  of  which  seemed  unaccountable.  The  follow- 
ing observation  made  by  Hippocrates  appears  to  relate 
to  a  hysterical  accident:  "The  wife  of  Polemachus, 
having  an  arthritical  affection,  felt  a  sudden  pain  in  her 
hip,  as  her  menses  had  not  come ;  having  drunk  some 
beet-root  water^  she  remained  voiceless  for  the  whole 
night  until  mid-day.  She  could  hear  and  understand  ; 

1  Pierre  Marie,  "  La  Revision  de  la  Question  de  1'Aphasie," 
Semaine  Medicale,  1906. 

T 


2io     The  Major  Symptoms  of  Hysteria 

she  showed  with  her  hand  that  the  pain  was  in  her  hip." 
This  description  seems  to  contain  everything,  the  stop- 
ping of  the  menses,  the  arthritic  disturbances,  which 
are  probably  disturbances  of  motion,  the  preservation 
of  the  perceptions  of  speech,  and  the  dumbness.  It  is 
not  necessary  to  remind  you  of  the  story  of  Croesus's 
son,  the  dumb  young  man  who  suddenly  recovers  his 
speech  to  cry:  "Soldier,  do  not  kill  Crcesus." 

We  may  pass  on  to  modern  times,  and  remind  you  of 
all  the  stories  of  dumbness  in  possessed  people  and 
ecstatics.  I  have  already  alluded  to  Carre  de  Mont- 
geron's  work  on  the  "Miracles  of  Deacon  Paris," 
in  which  you  can  read  the  case  of  Marguerite  Francoise 
Duchesne.  After  a  fit  of  lethargy  which  lasted  seven  or 
eight  days,  there  appeared  a  nearly  total  loss  of  voice. 
She  was  deprived  of  everything,  even  of  the  power  of 
complaining.  A  month  afterwards,  she  recovered  her 
hearing  and  sight,  but  it  was  not  the  same  with  her 
voice,  which  was  never  restored  to  her.  In  the  nine- 
teenth century,  such  cases  become  more  numerous. 
The  English  surgeon  Watson  boasted  of  having,  through 
an  electric  treatment,  restored  the  power  of  speech  to 
a  young  lady  who  had  been  voiceless  and  dumb  for 
twelve  years.  Briquet,  Kussmaul,  Revillod,  Charcot, 
and  Cartaz  insisted  very  strongly  on  these  phenomena, 
which  are  now  well-known  in  their  ensemble. 

This  accident  may  happen  to  confirmed  hysterics, 
who  have  already  had  many  accidents  of  the  neurosis, 
after  a  somnambulism  or  a  fit,  but  they  may  also  happen 
to  people  who  have  hitherto  seemed  nearly  normal. 
It  is  almost  always  brought  on  by  a  great  and  somewhat 


The  Troubles  of  Speech  211 

sudden  emotion.  It  was  so,  for  instance,  in  the  classi- 
cal case  studied  by  Charcot.  A  man  of  about  forty, 
living  in  a  little  town,  had  saved  some  money ;  his  wife 
persuaded  him  to  come  and  spend  it  in  Paris.  He 
settled  with  her  in  an  hotel  in  the  metropolis.  One  day, 
after  a  short  absence,  he  came  back  to  the  hotel  and 
found  that  his  wife  had  disappeared,  taking  the  little 
hoard  with  her.  The  poor  man  was  so  upset  that  he 
was  deprived  of  utterance,  and  remained  speechless  for 
eighteen  months.  Now,  though  seemingly  cured,  he 
is  still  liable  to  the  same  accident ;  at  the  least  emotion 
or  fatigue,  he  loses  again  the  use  of  speech  for  a  fortnight 
or  for  two  months.  Notice  by  the  way  this  character 
of  hysteria :  when  an  accident  has  once  happened  in  a 
particular  and  serious  form,  it  is  always  the  same  ac- 
cident that  reappears  on  every  occasion. 

The  same  remark  applies  to  the  following  observa- 
tion which  I  have  noted  down :  A  man  who  is  now  forty- 
six  has  been  ill  since  he  was  twenty.  One  day  at  that 
period  he  was  in  a  garden  near  a  glass  veranda;  a 
heavy  object  thrown  from  one  of  the  upper  floors  fell 
on  the  veranda  and  broke  some  of  the  glass  with  a 
noise  like  the  report  of  a  gun.  Our  man  was  very 
much  frightened  and  remained  dumb  for  two  months. 
Though  twenty-six  years  have  elapsed  since  the  accident, 
he  never  recovered  from  it ;  the  slightest  noise  he  hears 
suddenly  near  him,  a  word  spoken  somewhat  too  loud, 
is  enough  to  make  him  dumb  again  for  thirty  or  fifty 
days.  In  other  observations,  the  dumbness  begins 
in  young  women  of  twenty  on  occasion  of  a  fire,  of  the 
breaking  off  of  a  betrothal,  or  of  a  quarrel  with  their 


212      The  Major  Symptoms  of  Hysteria 

parents.  In  one  case  it  is  caused  by  the  sudden  ap- 
pearance of  a  man  disguised  as  a  spectre ;  the  accident 
happened  when  she  was  eighteen  and  is  not  yet  cured 
at  forty-one. 

Sometimes  the  emotion  bears  particularly  on  the  organs 
of  speech  or  respiration :  it  comes  on  after  a  sore  throat 
or  a  disease  of  the  chest.  In  certain  cases,  one  must 
not  forget  that  the  accidents  bore  on  the  right  side  of 
the  body.  A  young  man  of  eighteen  fell  from  horse- 
back on  his  right  knee;  the  consequence  was  a  really 
hysterical  hemiplegy  of  his  right  side  and  dumbness. 
A  young  woman  working  in  a  tavern  hurt  her  right 
hand  with  a  broken  bottle.  She  was  first  paralyzed 
in  her  right  side,  and  this  paralysis  seemed  to  extend  to 
the  throat,  for  she  lost  the  use  of  speech.  These  last 
cases  are  important  in  regard  to  the  association  of  paraly- 
ses of  the  right  side  with  aphasias.  In  another  curious 
case  I  will  remind  you  of  the  story  of  a  woman,  a  great 
spiritualistic  medium,  who,  after  having  too  often  made 
use  of  automatic  writing,  was  affected  with  hysterical 
dumbness.  This  again  is  interesting  as  regards  the 
interpretation. 

However  it  may  be,  when  this  dumbness  is  constituted, 
it  appears  nearly  always  in  the  same  manner  of  which 
Charcot  gave  a  very  famous  and  vivid  picture.  The 
patient,  save  in  exceptional  cases,  looks  healthy  and  is 
not  paralyzed.  He  has  not  that  weak  and  sickly  ap- 
pearance of  persons  struck  with  an  organic  hemiplegy 
consequent  on  a  cerebral  hemorrhage.  Nor  does  he 
offer  a  very  visible  intellectual  weakness,  the  dazed  look 
of  the  latter  patients;  on  the  contrary,  he  seems  intel- 


The  Troubles  of  Speech  213 

ligent  and  lively.  He  comes  forward  with  an  expres- 
sive face,  understands  all  you  tell  him,  but  takes  a 
singular  attitude  when  he  has  to  answer.  The  charac- 
teristic fact  is  that  he  does  not  try  to  answer;  he  does 
not  make  those  efforts  of  speech  that  an  aphasic  person 
makes,  or  that  a  foreigner  makes  when  trying  to  ex- 
press himself  in  a  language  he  knows  imperfectly. 
He  does  not  look  as  if  he  thought  it  possible  to  answer 
with  words ;  he  does  not  open  his  mouth ;  he  makes  no 
sound ;  he  answers  with  signs,  or  else  takes  up  a  pencil 
and  answers  in  writing.  In  a  word,  there  is  no  imper- 
fect speech,  there  is  no  speech  at  all,  and  there  does  not 
even  seem  to  be  any  idea  or  remembrance  or  wish  of 
speech.  The  subject  seems  to  have  forgotten  that  use 
which  men,  right  or  wrong,  have  made  of  their  mouths. 
I  insist  on  this  character,  because  all  the  authors,  with 
much  exaggeration  in  my  opinion,  make  it  a  sign  of 
distinction  between  organic  aphasia  and  hysterical 
dumbness. 

When  you  try  to  realize  the  reason  of  this  silence, 
which  has  often  lasted  for  months  together,  you  examine 
the  different  peripheric  organs  and  then  notice  the  second 
character  of  our  affection ;  namely,  the  total  absence  of 
paralytic  phenomena.  The  lips,  cheeks,  tongue,  and 
soft  palate  move  easily  in  the  most  correct  way.  The 
patient,  who  understands  everything,  does  all  he  is 
asked,  moves  his  lips,  bares  his  teeth,  smiles,  draws  his 
lips  one  way  or  the  other,  makes  all  the  movements  of 
his  tongue,  and  that  without  difficulty. '  No  doubt 
I  think,  in  certain  cases,  some  reservation  should  be 
made  about  this  somewhat  too  theoretical  description  of 


214      The  Major  Symptoms  of  Hysteria 

Charcot's ;  you  will  very  often  find  in  these  mutes  cer- 
tain small  localized  disturbances  of  such  or  such  an 
organ,  for  instance  slight  contractures  of  some  muscle 
of  the  tongue.  You  must  seek  for  them  carefully,  for 
it  is  important  to  do  away  with  them  before  trying  to 
bring  back  speech.  You  will  also  remark  that  the 
movements  of  the  lips  are  not  so  perfect  as  Charcot 
said :  there  is  no  paralysis,  properly  so  called,  but  there 
is  often  awkwardness,  clumsiness,  and  ugliness.  Yes, 
ugliness;  these  subjects,  whose  mind  retrogrades,  in 
my  opinion,  lose  the  delicacy,  the  perfection,  of  certain 
functions,  and  you  can  very  well  notice  their  return  to 
animality  from  the  vulgarity  of  certain  delicate  move- 
ments. However,  I  readily  recognize  that  these  motor 
impairments  are  slight,  and  quite  inadequate  to  account 
for  the  enormous  paralyses  of  speech  which  are  to  be 
observed. 

If  we  go  farther,  we  try  to  study  the  condition  of  the 
vocal  chords.  This  study,  begun  in  Charcot's  time, 
is  summarized  in  the  thesis  of  Cartaz.  He  recognizes 
that,  in  reality,  there  is  no  great  disturbance  in  the  vocal 
chords.  Certain  authors  have  tried  to  establish  a 
certain  degree  of  paresis  in  the  adduction,  but  I  fear 
they  have  deluded  themselves.  The  only  means  we 
know  to  establish  the  drawing  nearer  of  the  vocal 
chords  is  to  ask  the  subject  to  speak  or  utter  a  sound. 
Now,  as  he  cannot  speak  or  cry,  he  does  not  produce 
this  movement  before  us.  There  is  nothing  to  prove 
that  the  vocal  chords  are  not  able  to  accomplish  it,  if 
it  were  asked  of  them.  So  we  are  again  obliged  to 
appeal  to  moral  phenomena  in  order  to  explain  the 


The  Troubles  of  Speech  215 

hysterical  syndrome,  and  all  the  authors  are  obliged  to 
acknowledge  that  the  disturbance  is  purely  mental. 


II 

One  of  the  things  that,  in  my  opinion,  obscured  this 
study  at  the  outset  and  brought  on  many  difficulties  is 
the  difference  that  physicians  at  once  wished  to  estab- 
lish between  these  hysterical  mutisms  and  the  aphasias 
accompanied  with  right-sided  paralyses  which  were 
observed  to  succeed  hemorrhages  and  softenings  of  the 
brain,  and  whose  cerebral  localizations  were  so  eagerly 
studied  in  imitation  of  Broca.  Aphasias  with  destruc- 
tion of  the  third  frontal  convolution  were,  it  was  said, 
the  true  impairments  of  the  psycho-physiological  func- 
tion of  speech;  and  these  aphasias  do  not  present  the 
same  symptoms  as  hysterical  dumbness. 

In  aphasias,  the  subject  feels  that  he  has  lost  the  use 
of  speech,  and  he  makes  desperate  efforts  to  express 
himself.  These  efforts  have  some  success,  for  he  has 
never  lost  all  power  to  utter  a  sound;  he  can  give 
cries,  make  varied  noises  with  his  larynx;  oftenest  he 
has  even  retained  a  few  words,  which  have  more  or 
less  meaning,  as  "papa,  come,  come  .  .  .  macassi; 
macassa  ..."  which  he  repeats  at  random,  some- 
times oddly  varying  the  intonation. 

On  the  other  h|nd,  the  disturbance  spreads  farther; 
a  patient  who  cannot  speak  at  all  very  seldom  keeps 
all  the  other  functions  of  speech  intact.  He  has  nearly 
always  considerable  disturbances  of  writing;  he  can 
no  more  read,  or  he  reads  with  difficulty,  without 


2i6      The  Major  Symptoms  of  Hysteria 

understanding  the  meaning  of  what  he  spells;  lastly, 
he  does  not  thoroughly  understand  the  words  spoken 
before  him.  These  different  disturbances,  which  nearly 
always  exist  in  germ  in  aphasia  properly  so  called,  may 
develop  separately.  You  know  the  classification  of  the 
disturbances  of  speech  made  in  this  connection  accord- 
ing to  the  predominance  of  such  or  such  a  symptom: 
motor  aphasias,  agraphias,  sensorial  aphasias  with 
word-blindness  and  word-deafness  have  been  de- 
scribed. Nothing  of  the  kind,  it  has  been  said,  is  to 
be  found  in  hysterical  dumbness,  which  seems  to  be  at 
once  more  extended  and  more  restricted.  It  is  more  ex- 
tended, for  in  this  case,  motor  speech  is  more  distinctly 
done  away  with,  and  the  subject  does  not  seem  even  to 
make  efforts  to  speak,  as  aphasia1  patients  do.  It  is 
more  restricted,  for  the  disease  seems  to  be  limited  to 
the  expression  of  words  and  not  to  impair  kindred  phe- 
nomena, such  as  writing,  reading,  and  the  understand- 
ing of  words  perceived  by  the  ear.  So  the  two  things  are 
different,  and  as  aphasia  was  considered  as  the  impair- 
ment of  the  function  and  of  the  centre  of  speech,  hys- 
terical dumbness  was  necessarily  quite  another  thing. 
To  these  remarks,  which  I  think  quite  wrong,  we 
must  first  answer  clinically.  Hysterical  dumbness, 
which  I  have  described  to  you  after  Charcot,  is  a  type, 
this  word  being  taken  in  the  sense  given  to  it  by  this 
author.  It  is  a  particular  and  striking  case,  which  is 
very  remarkable  from  many  points  of  view,  but  was  some- 
what arbitrarily  chosen.  You  must  not  fancy  that,  all 
the  disturbances  of  speech  brought  on  by  hysteria  are 
always  conformable  to  this  theoretical  model. 


The  Troubles  of  Speech  217 

We  have  first  to  put  beside  it  many  attenuated,  im- 
perfect, or  rather  incomplete  forms,  in  which  the  func- 
tion of  language  is  analyzed  as  the  visual  function  was 
before.  One  of  the  most  frequent  forms  distinguishes 
the  two  degrees  of  vocal  power  we  have  at  our  disposal. 
We  have  the  loud  voice  with  intense  sounds,  which 
enables  us  to  be  heard  in  public,  and  we  have  the  whis- 
pering voice,  in  which  the  movement  of  the  lips  and 
tongue  is  complete,  but  in  which  there  is  very  little 
emission  of  air.  Very  often  in  hysteria,  the  first  voice 
is  lost  and  the  second  is  kept ;  it  is  what  is  called  apho- 
nia. In  certain  cases,  the  dissociation  is  still  nicer; 
certain  subjects  can  sing  aloud  and  cannot  speak  ex- 
cept in  whispers.  These  distinctions  will  remind  you 
of  astasia-abasia.  In  still  other  cases,  there  are  only 
slighter  disturbances  of  speech :  the  subject  can  speak, 
but  stammers,  or  stutters,  or  has  a  special  voice  more  or 
less  different  from  his  normal  voice.  I  do  not  insist  on 
these  varieties,  because  it  is  more  important  to  study 
the  varieties  approaching  the  table  of  aphasia  properly 
so  called. 

In  my  opinion,  many  hystericals  have  disturbances 
of  speech  quite  identical  with  those  described  as  suc- 
ceeding an  apoplectic  ictus.  Here  is  an  observation  I 
borrow  from  the  second  volume  of  my  "  NeVroses  et 
Idees  fixes,"  page  452.  A  young  woman  of  twenty,  in 
consequence  of  various  emotions,  shows  for  a  few  hours 
or  days  a  very  singular  disturbance  of  speech,  that  little 
resembles  typical  hysterical  dumbness.  First  of  all, 
she  is  not  voiceless,  and  can  make  a  noise  with  her 
larynx;  she  even  utters  cries,  either  spontaneously 


2i 8      The  Major  Symptoms  of  Hysteria 

or  when  she  is  asked.  Nor  is  she  quite  dumb,  for  she 
tries  to  speak,  which  the  preceding  patients  did  not  do. 
She  makes  with  her  tongue  and  lips  movements  that 
produce  articulate  sounds;  but  these  sounds  have  no 
meaning,  and  they  nearly  always  consist  in  the  repeti- 
tion of  a  few  incomprehensible  syllables.  If  I  say  to 
her:  "Miss  X.,  you  walk  much  better  to-day,"  she  an- 
swers, smiling:  " petitbedable,  petitbedable,  chacha 
petitbedable."  —  To  the  question:  "What  happened 
to  you  to-day?"  she  replies  very  quickly:  "Petitbed- 
able, chapetit,  petitbedable."  We  can  draw  nothing 
more  from  her;  she  will  go  on  with  this  "jargonnage," 
as  she  says,  for  a  few  hours.  Notice  that  we  have  here 
a  real  oblivion  of  the  movements  necessary  for  the  pro- 
nunciation of  words.  She  is  impatient  at  not  being 
understood,  and  seeks  to  answer  by  giving  different 
intonations  to  her  word  "petitbedable."  It  seemed 
to  us  that  the  intonations  were  often  right,  as  well  as 
the  expressions  of  the  face,  but  the  words  never  changed. 
Are  other  functions  of  speech  disturbed  ?  The  audi- 
tion of  words  is  not  disturbed  in  the  least,  she  can 
understand  very  correctly  all  that  is  said  to  her.  She 
reads  very  well ;  I  mean  that  she  does  all  you  ask  her  in 
writing,  but  she  is  unable  to  read  aloud.  As  for  writ- 
ing, it  is  not  totally  lost,  but  there  is  a  phenomenon 
that  appears  to  us  worthy  of  remark.  The  writing  has 
quite  changed;  it  has  become  very  bad;  it  is  curious 
to  compare  her  writing  during  this  state  with  her  nor- 
mal writing.  You  see  that  the  faculty  of  writing  is 
markedly  diminished,  if  not  entirely  lost.  How  can 
we  designate  these  symptoms,  if  not  by  the  usual  words 


The  Troubles  of  Speech  219 

of  motor  aphasia  or  aphemia  with  a  certain  degree  of 
agraphia  ? 

It  is  needless  to  demonstrate  here  that  these  symptoms 
are  hysterical:  with  such  a  patient,  the  demonstration 
would  be  superfluous.  Besides,  these  phenomena  will 
disappear  in  a  few  hours ;  we  could,  if  we  chose,  cause 
them  to  disappear  immediately.  During  the  hypnotic 
sleep,  which  is  easily  induced,  the  patient  will  at  once 
assume  a  normal  manner  of  speaking.  What  is  more, 
as  we  shall  see  presently,  the  subject  presents,  even 
during  her  periods  of  disturbance,  automatic  words, 
which  she  utters  during  a  state  of  delirium,  and  which 
are  quite  normal.  It  is  then  an  altogether  hysterical 
phenomenon,  and  yet,  as  you  see,  it  differs  in  no  way 
from  an  organic  aphasia.  Such  cases  might  easily 
be  multiplied. 

Besides  these  cases,  you  can  observe  as  many  phe- 
nomena of  agraphia  as  you  please.  I  have  already 
indicated  to  you  the  loss  of  writing  as  one  of  the  possible 
forms  of  systematic  paralysis.  Charcot  already  pointed 
out  some  such  cases  in  his  "Le9ons  du  Mardi," l  Lepine, 
Ballet,  Sollier  published  some,  I  observed  several. 
You  may  even  observe  some  curious  forms,  in  which 
the  writing  becomes  again  childish  and  is  quite  like  old 
writing  books  of  the  patient. 

Can  we  go  further?  Do  there  exist  in  hysteria 
word-blindness  and  word-deafness?  For  my  part,  I 
am  convinced  of  it,  and  I  do  not  see  why  this  dissocia- 
tion should  not  take  place  when  all  the  others  do.  It 
must  be  acknowledged,  however,  that  cases  of  this  kind 

1  T.  M.  Charcot,  "  Lejons  du  Mardi,"  p.  367. 


22O      The    Major  Symptoms  of  Hysteria 

have  seldom  been  published.  I  therefore  recommend 
to  you  to  study  an  observation  that  in  my  opinion  is 
important,  the  one  which  concerns  a  young  girl  called 
Rachel,  and  which  I  published  in  the  second  volume  of 
my  book  on  "  Neuroses  and  Fixed  Ideas."  '  The  obser- 
vation and  the  discussion  are  too  long  to  reproduce  here. 
I  only  point  out  the  principal  points.  A  girl  of  nineteen 
has  a  strange  bearing.  As  soon  as  we  speak  to  her,  she 
looks  embarrassed ;  she  does  not  answer,  moves  on  her 
chair,  moans,  and  at  last  says:  "I  do  not  understand, 
I  cannot  understand."  At  first  sight  it  looks  as  if 
she  were  deaf ;  that  is,  moreover,  the  dominant  opinion 
entertained  about  her  in  her  surroundings.  Yet  this 
opinion  is  not  right.  If  you  make  a  noise  behind  her, 
she  almost  always  turns  round.  Curiously  enough, 
if  you  put  a  watch  near  her  ear,  she  declares  that  she 
hears ;  you  may  thus  recognize  that  she  hears  the  tick- 
ing of  the  watch  at  sixty  centimetres  on  the  right  and 
at  forty  on  the  left.  The  hearing  of  this  girl  was  very 
carefully  examined  by  M.  Gell£  two  different  times. 
His  conclusions  were  always  the  same  and  quite  defi- 
nite; this  patient  is  not  deaf  by  any  means;  all  we 
can  say  is  that  there  is  a  slight  diminution  of  the  audi- 
tory acuity,  especially  on  the  left.  There  is  no  appreci- 
able lesion  of  the  external  auditory  apparatus. 

But  then  why  does  not  this  patient  answer  us? 
Because,  as  she  says  herself,  she  does  not  understand. 
Though  she  hears  our  words,  they  have  no  meaning 
for  her.  It  is  the  same  with  musical  airs.  She  hears 
them  very  well,  but  she  does  not  recognize,  does  not 

1  "  Ne*vroses  et  Id£es  fixes,"  1898,  II,  p.  456,  Observation  134. 


The  Troubles  of  Speech  221 

understand  them.  In  a  word,  it  is  the  syndrome  well 
known  under  the  name  of  word-deafness.  In  the 
present  case,  this  word-deafness  is  quite  complete. 
The  patient  has  also  completely  lost  the  functions  that 
appear  to  depend  on  word  audition.  She  is  quite  in- 
capable of  writing  from  dictation,  and  of  repeating, 
even  without  understanding  them,  the  words  spoken 
before  her.  They  are  noises,  she  says,  and  she  does  not 
know  how  she  could  manage  to  repeat  them.  The 
disappearance  of  that  connection  between  sounds  and 
movements  has  often  been  noticed  in  word-deafness. 
If  the  word-deafness  is  complete,  it  is  none  the  less  very 
isolated,  that  is  to  say,  all  the  functions  of  speech  save 
the  audition  of  words  seem  to  have  remained  quite 
intact. 

Now  what  are  the  diagnosis  and  origin  of  this  clini- 
cally incontestable  word  deafness?  They  are  most 
strange.  A  few  years  ago,  this  already  impressionable 
and  nervous  girl  was  being  educated  in  a  convent.  At 
the  age  of  twelve,  she  had  a  typhoid  fever,  and  remained 
weak  and  nervous,  though  still  intelligent  and  free 
from  any  disturbance  of  speech  or  hearing.  A  short 
time  afterwards,  she  began  to  present  odd  symptoms, 
about  which,  unfortunately,  we  have  quite  insufficient 
information,  for  they  were  only  observed  by  the  nuns 
of  the  convent.  The  child  had  a  disposition  to  fall 
asleep  in  the  middle  of  the  day,  especially  between 
one  and  four  in  the  afternoon.  These  sleeps  were 
sometimes  complete  and  very  deep,  nor  could  anything 
awaken  the  sleeper,  who  did  not  even  feel  prickings 
made  in  her  arm.  On  other  days,  the  sleep  seemed 


222      The  Major  Symptoms  of  Hysteria 

less  profound,  since  the  child  kept  her  eyes  open  and 
went  on  with  her  sewing.  But  she  did  not  answer, 
could  not  be  disturbed,  and,  on  awaking,  would  say 
that  she  had  done  nothing  and  was  surprised  to  see  her 
work  getting  on.  This  is  all  we  know  about  those 
sleeps,  which  lasted  for  nearly  two  years  with  the  same 
characteristics.  One  day  the  nuns  became  incensed 
at  these  continual  sleeps  and  punished  the  child,  but 
it  was  of  no  use.  The  chaplain  was  sent  for,  and  it  was 
demonstrated  to  her,  in  a  fine  exhortation,  that  if  she 
slept  again,  she  should  first  be  shut  up  in  a  dark  room 
and  later  on,  go  to  hell.  The  little  girl  was  frightened 
and  swore  that  she  would  sleep  no  more.  When  the 
hour  of  her  usual  sleep  came,  she  contrived,  through 
desperate  efforts,  to  remain  awake.  It  is  impossible 
for  us  to  know  exactly  what  happened.  Rachel  asserts 
she  had  no  convulsions,  went  on  with  her  sewing,  but 
felt  her  mind  confused  and  her  head,  as  it  were,  clogged. 
Moreover,  her  recollection  in  this  respect  is  very 
vague. 

However  it  may  be,  after  a  few  hours'  discomfort,  she 
realized  that  she  was  no  longer  sleepy  at  all.  When  she 
was  spoken  to,  she  did  not  answer,  and  her  features 
assumed  a  dazed  expression ;  every  endeavour  was  used 
to  rouse  her,  but  it  was  soon  noticed  that  she  understood 
nothing  and  answered  very  badly.  What  was  exactly 
the  extent  of  the  disturbance  at  the  outset?  Our  in- 
formation is  insufficient ;  it  seems  certain  that  there  was 
no  paralysis,  but  it  seems  that  speech  was  disturbed  as 
well  as  hearing.  However  it  may  be,  the  disturbance  of 
speech  did  not  persist.  After  a  few  weeks,  she  spoke 


The  Troubles  of  Speech  223 

correctly,  as  now ;  she  had  only  a  somewhat  odd  accent ; 
but  the  hearing  of  words  made  no  progress.  She  re- 
mained, as  at  the  outset,  incapable  of  understanding 
anything. 

No  doubt,  all  this  is  not  very  definite,  and  we  may 
wish  to  find,  later  on,  more  distinct  observations  of  hys- 
terical word- blindness  and  word-deafness.  However, 
these  sleeps,  these  somnambulisms,  the  neuropathic 
disturbances  which  still  persist,  the  total  absence  of 
any  symptom  of  cerebral  lesion  or  lesion  of  the  ear, 
seem  to  prove  that  the  disease  approaches  the  great 
neurosis. 

These  observations,  which  could  easily  be  multiplied, 
show  you  distinctly  enough,  I  think,  that,  besides  the 
classical  and  typical  hysterical  dumbness,  there  are  all 
kinds  of  forms  of  this  affection,  and  that  some  of  these 
forms  are  quite  identical  with  what  is  understood  under 
the  name  of  aphasia.  So  there  is  no  opposition  be- 
tween those  two  groups  of  symptoms;  the  hysterical 
dumbness  of  Charcot  is  nothing  but  a  more  sharply 
differentiated,  more  isolated  form  of  the  disturbances 
of  speech.  The  subject  loses  absolutely  the  power  of 
speaking,  and  loses  only  that.  He  loses  that  power 
so  entirely  that  he  forgets  it  and  does  not  regret  it,  so 
that  he  has  no  longer  even  the  idea  of  the  efforts  to  be 
made.  This  we  already  saw  when  studying  hysterical 
paralyses  and  anesthesias.  It  is,  therefore,  very  likely 
that  the  function  of  speech  is  also  disturbed  in  the 
same  manner  in  all  those  organic  and  neuropathic  ac- 
cidents. 


224      The  Major  Symptoms  of  Hysteria 


III 

To  understand  the  impairment  of  this  function  of 
speech,  we  must  rapidly  make  some  remarks  which  you 
already  know.  Let  us  take  up  again  the  observation 
of  the  hysterical  who  to  all  the  questions  put  to  her 
could  only  reply  with  the  words :  "  chacha  petitbedable." 
Often,  in  the  midst  of  this  state  of  aphasia,  the  patient 
had  kinds  of  reveries  or  deliriums,  in  which  she  expressed 
aloud,  either  fixed  ideas  which  preoccupied  her,  or 
conversations  she  had  just  had,  in  which  she  put  the 
questions  and  made  the  answers  herself.  In  all  those 
slight  deliriums,  she  spoke  very  correctly,  either  in 
French  or  in  English,  and  there  was  no  trace  of  aphasia 
left.  Observe  that,  in  all  those  chatterings, '  she  said 
things  she  regretted  later  on,  expressing  her  secrets 
aloud.  They  were  quite  involuntary  words.  If  you 
interrupted  her,  if  you  attracted  her  attention  to  ask 
her  to  reply  to  a  question  you  put  her,  she  listened, 
tried  to  speak,  and  no  longer  said  anything  but  "petitbe- 
dable." In  a  word,  there  was  aphasia  in  conscious  and 
voluntary  speech,  and  the  normal  expression  of  ideas 
reappeared  only  in  the  deliriums  and  automatic  speech. 

This  fact  is  more  general  than  is  commonly  believed. 
In  patients  affected  with  dumbness  you  may  often  recog- 
nize, in  the  period  of  dumbness  itself,  that  normal 
speech  reappears  during  the  crises,  the  somnambulisms, 
the  dreams.  Oppenheim  indicated  some  facts  of  this 
kind,  Gilles  de  la  Tourette  describes  a  dumb  patient  who 
speaks  during  her  dreams. 


The  Troubles  of  Speech  225 

^ 

More  often  still  those  automatic  and  irrepressible 
words  do  not  coincide  exactly  with  the  period  of  dumb- 
ness, but  present  themselves  in  the  same  patients  be- 
fore or  after  this  period.  We  then  find  in  these  sub- 
jects crises  of  irresistible  chattering,  to  which  we  already 
alluded  in  connection  with  somnambulisms.  Some- 
times these  crises  come  on  during  a  sleep  or  an  ab- 
normal state,  but  often  they  take  place  while  the  patient 
is  awake,  and  then  he  listens  in  astonishment  to  the 
words  he  speaks.  Read  again,  in  the  history  of  the 
Camisards  in  the  seventeenth  century,  the  anecdotes 
relating  to  the  lesser  prophets  of  the  CeVennes,  and  to 
the  most  celebrated  among  them  all,  Elie  Marion.  He 
felt  himself,  as  it  were,  seized  by  the  Lord,  he  could  no 
longer  dispose  of  his  voice,  or  speak  voluntarily,  he 
did  not  know  what  his  mouth  was  about  to  utter,  and 
was  quite  surprised  at  hearing  the  fine  discourses  with 
which  the  Holy  Ghost  inspired  him.  This  verbal 
automatism  should  be  placed  beside  the  automatism 
of  writing  in  the  spiritualistic  medium.  He  also  feels 
that  his  hand  escapes  his  control  and  is  no  longer  ruled 
by  his  will ;  he  is  quite  surprised  at  seeing  what  his  hand 
has  written.  It  is  a  phenomenon  of  the  same  kind. 
With  the  same  group  are  also  to  be  connected  the 
tics  of  speech,  which  are  numberless  in  the  form  of 
coprolalia,  echolalia,  etc.  You  will  find  a  very  good 
description  of  them  in  the  little  book  of  M.  Seglas  on  the 
disturbances  of  speech.  I  should  be  inclined  to  go 
even  further  and  to  say  that  many  verbal  hallucinations 
of  inner  words  are  phenomena  of  the  same  kind,  though 
somewhat  less  marked.  In  all  these  facts,  the  function 
Q 


226      The  Major  Symptoms  of  Hysteria 

of  speech,  which  is  by  no  means  destroyed,  seems  to 
escape  the  conscious  will  of  the  subject.  Inwardly  or 
outwardly,  he  speaks  in  spite  of  himself  and  without 
any  participation  of  his  self :  it  is  a  mechanism  which 
has  emancipated  itself. 

Well  I  believe  that  for  this  fact  as  for  the  preceding 
ones,  this  symptom  of  agitation,  of  automatic  function- 
ing of  the  function,  should  be  placed  beside  the  paralysis 
bearing  on  the  same  function.  They  are  two  parallel 
and  concomitant  phenomena.  One  more  example 
occurs  to  me.  Bes.  had  very  varied  crises  in  the 
hospital.  After  her  ordinary  crises,  in  which  she  had 
cried  to  exhaustion,  she  retained  perfectly  the  power  of 
speaking.  But  she  had  special  crises  in  which  her 
speech  seemed,  as  it  were,  to  be  thrown  out  of  gear, 
in  which  she  chattered  in  a  low  voice  with  extreme 
volubility.  After  these  crises  she  always  awoke  dumb ; 
the  emancipation  of  speech  brought  on  dumbness. 
This  we  have  already  seen  in  the  somnambulism  that 
brings  about  amnesia,  in  chorea  and  in  the  tic  that 
brings  about  paralysis. 

Here  again  everything  happens  as  if  the  system  of 
the  movements  and  images  that  constitute  speech 
separated  from  the  personality  and  functioned  apart 
in  an  automatic,  and  at  the  same  time  inferior,  and,  as 
it  were,  degraded,  manner. 


LECTURE  XI 
THE  DISTURBANCES  OF  ALIMENTATION 

Visceral  troubles  —  Hysterical  anorexy  —  The  description 
oj  its  three  periods :  the  gastric  period,  the  moral  period, 
the  period  of  inanition  —  The  frequent  termination  by 
death  —  The  theory  of  the  fixed  idea  —  The  diagnosis 
with  the  psychasthenic  refusal  of  food  —  The  theory  of 
anorexy  through  the  anesthesia  of  the  stomach  —  The 
part  played  by  anesthesia  in  the  modifications  of  the  feeling 
of  hunger  —  The  motor  agitation  of  the  patient  —  The  dif- 
ferent explanations  of  this  fondness  for  physical  exer- 
cises —  The  suppression  of  the  feeling  of  fatigue  and  the 
motor  excitation  —  The  psychological  function  of  alimen- 
tation —  The  hysterical  dissociation  of  this  function  — 
The  dissociation  of  the  elements  of  this  junction  —  The 
paralyses  of  the  lips,  tongue,  pharynx,  oesophagus,  abdo- 
men —  The  troubles  of  the  function  of  the  bladder 

AFTER  passing  in  review  the  mental  disturbances  of 
hystericals,  their  sensory  and  motor  disturbances,  we 
shall  now  enter  upon  a  rapid  survey  of  their  visceral 
disturbances.  These  patients,  in  fact,  seem  to  present 
great  impairments  of  the  visceral  functions,  especially 
of  the  functions  of  digestion  and  respiration.  These 
visceral  phenomena  have  always  greatly  puzzled  physi- 
cians, and  nowadays  they  are  still  often  opposed  to 
those  who  want  to  give  a  mental  explanation  of  this 
disease.  We  must,  therefore,  insist  on  their  interpreta 

227 


228      The  Major  Symptoms  of  Hysteria 

0 

tion.  To  penetrate  into  the  study  of  the  mental  dis- 
turbances of  hysteria,  we  shall  begin  by  studying  a  very 
important  phenomenon,  that  of  anorexy,  which  by 
its  character,  at  once  physiological  and  mental,  will 
furnish  a  transition  between  these  new  studies  and  the 
preceding  ones. 

I 

The  words  "hysterical  anorexy"  designate  a  disease 
both  mental  and  physiological,  very  long  and  very  com- 
plicated, which  consists  chiefly  in  the  systematic  refusal 
of  food,  in  certain  digestive  disturbances,  and  in  a  con- 
sequent inanition.  This  odd  phenomenon  was  for  a 
long  time  very  ill  known;  it  was  confusedly  ranged 
among  the  other  manias  of  those  patients,  and  their 
strange  way  of  living  without  eating  was  often  ascribed 
to  the  action  of  the  demon  or  to  that  of  God. 

Its  accurate  description  is  recent ;  it  was  made  almost 
simultaneously  by  W.  Gull,  in  1868,  and  by  Lasegue 
in  1873.  The  article  of  Lasegue  was  the  only  one  that 
had  success  and  contributed  to  spread  this  new  medical 
notion ;  it  led  Gull  to  observe  in  1873 tnat  ^e  nad  already 
indicated  these  facts  in  1868.  The  English  physician 
called  this  disease  "apepsia  hysterica";  Lasegue 
named  it  "hysterical  anorexy."  Neither  of  these  two 
appellations  is  perfect ;  the  absence  of  pepsine,  which, 
moreover,  is  doubtful,  has  nothing  interesting  in  it 
here ;  the  loss  of  appetite  is  more  important,  but  it  is  not 
certain  that  it  is  the  essential  characteristic.  There- 
fore, some  subsequent  authors,  wishing  to  emphasize 
the  capital  fact,  which  is  the  systematic  refusal  of  food, 


The  Disturbances  of  Alimentation       229 

made  use  of  the  words  "sitiophobia,"  that  is  to  say, 
aversion  to  food,  and  "sitieirgia"  (a-inov  etpyat), 
food  repelling,  that  is  to  say,  rejection  of  food ;  or  even 
of  the  words  "hysterical  inanition"  which  Lasegue  had 
also  proposed.  The  last  words  are  evidently  better, 
but  usage,  which  is  a  great  master,  has  not  accepted 
them  and  has  even  employed  them  differently.  It  has 
retained  the  term  hysterical  anorexy.  It  is  enough  if 
we  understand  one  another. 

This  accident  may  happen  in  the  course  of  hysteria 
after  many  characteristic  phenomena,  which  will  serve 
for  its  recognition.  Oftenest  it  forms  the  outset  of 
hysteria  and  its  real  nature  is  only  recognized  late. 
Many  cases  have  been  cited  in  adult  and  young  men, 
but  it  cannot  be  denied  that  it  is  infinitely  more  frequent 
in  women.  A  case  has  been  cited  at  the  age  of  eleven 
(Kissel) ;  I  have  observed  one  in  a  little  girl  of  nine ; 
it  has  also  been  recognized  in  a  woman  of  thirty-eight. 
Lately  I  studied  a  very  distinct  case  in  a  woman  of 
forty,  but  it  was  an  old  accident  which  reappeared. 
It  must  be  acknowledged  that  these  ages  are  quite 
exceptional ;  the  greatest  number  of  cases  by  far  —  nine 
out  of  ten  —  are  to  be  met  with  in  girls  of  sixteen  to 
twenty-three  or  twenty-five  at  most.  It  is  one  of  the 
facts  of  the  special  pathology  of  the  girl  of  eighteen. 
You  should  never  forget  it  when  in  presence  of  a 
patient  of  this  age. 

That  affection  which  seizes  the  girl  of  eighteen  is  a 
chronic  one.  It  is  a  disease  that  never  lasts  less  than 
eighteen  months  to  two  years,  and  often  continues  for  ten 
years.  The  result  is  that  it  goes  through  different  periods 


230     The  Major  Symptoms  of  Hysteria 

which  Lasegue  reduced,  rightly  enough,  to  three  prin- 
cipal ones. 

The  first  period  might  be  called  the  gastric  period, 
for  everybody  fancies  that  the  disease  consists  simply 
in  an  affection  of  the  stomach,  and  behaves  accordingly. 
The  beginning,  which  it  is  not  always  easy  to  know, 
often  coincides  with  a  slight,  more  or  less  real,  affection 
of  the  stomach.  More  often  it  is  again  the  consequence 
of  an  emotion.  Mu.,  for  instance,  a  girl  of  nineteen,  of 
whom  I  often  think  when  speaking  to  you  of  anorexy, 
presented  her  first  gastric  disturbances  after  the  death 
of  her  brother,  who  succumbed  rapidly  to  pulmonary 
phthisis.  The  patients  complain  of  various  and  vague 
sufferings,  which  they  connect  with  their  digestion. 
Then  come  consultations  on  consultations  and,  of  course, 
a  lot  of  absurd  diagnoses  and  ridiculous  medicines.  It 
is  thought  quite  natural  that  the  girl,  whose  stomach 
is  diseased,  should  be  careful  of  what  she  eats;  her 
medical  attendants  would  even  be  inclined  to  prescribe 
to  her  a  still  stricter  diet.  She  resigns  herself  to  every- 
thing and  shows  herself  a  patient  of  exemplary  docility ; 
moreover,  save  for  vaguer  and  vaguer  pains  in  her 
stomach,  she  seems  to  enjoy  perfect  health ;  her  tongue 
is  clean,  her  stomach  and  abdomen  normal;  the  only 
thing  she  may  suffer  from  is  obstinate  constipation. 

Usually,  after  a  long  time,  begins  the  second  period, 
the  moral  period,  or  period  of  struggling.  The  family 
at  length  become  disquieted  at  the  indefinite  prolonga- 
tion of  these  treatments  and  ultra  strict  diets,  which 
do  not  seem  very  well  justified.  They  suspect  hypo- 
chondriac ideas  and  obstinacy,  and  their  attitude  be- 


The  Disturbances  of  Alimentation       231 

comes  quite  modified.  Now  they  try  to  allure  the  pa- 
tient by  all  possible  delicacies  of  the  table,  they  scold 
her  severely,  they  alternately  spoil,  beseech,  threaten 
her.  The  excess  of  the  insistence  causes  an  exaggera- 
tion of  the  resistance ;  the  girl  seems  to  understand  that 
the  least  concession  on  her  part  would  cause  her  to  pass 
from  the  condition  of  a  patient  to  that  of  a  capricious 
child,  and  to  this  she  will  never  consent. 

All  the  relatives  and  friends  interfere  by  turns  to 
try  what  their  authority  and  influence  may  do.  Lasegue 
has  well  described  those  distressed  families  who,  all  day 
and  to  the  first  comer,  speak  mournfully  of  the  girl's 
food.  It's  all  of  no  use,  the  disease  develops  more  and 
more  under  the  influence  of  these  surroundings.  Now 
the  girl  scarcely  ever  speaks  of  her  pains  in  the  stomach, 
but  she  repeats  that  she  will  eat  when  she  is  hungry  and 
that  she  is  never  hungry,  that  she  does  not  need  more 
food,  that  she  can  very  well  live  indefinitely  in  that 
way,  that,  moreover,  she  has  never  felt  better.  In 
fact  she  seems  to  be  in  very  good  health  and  shows 
much  strength  and  activity.  She  has  even  a  greatly 
exaggerated  physical  and  moral  activity,  to  which  we 
shall  have  to  revert,  for  the  fact  is  very  important. 
Supported  by  this  conviction,  our  strange  patient 
struggles  with  all  those  around  her,  by  every  possible 
means.  She  seeks  a  support  in  one  of  her  parents 
against  the  other,  she  promises  to  do  wonders  if  her 
family  is  not  too  exacting,  she  has  recourse  to  every 
artifice  and  to  every  untruth.  It  is  the  period  when  such 
patients  hide  victuals  in  their  pockets,  fill  their  cheeks 
and  throat  with  them,  to  go  and  spit  them  out  in  the 


232      The  Major  Symptoms  of  Hysteria 

lavatory,  when  they  learn  to  vomit  immediately  what 
they  have  just  swallowed,  etc. 

Lastly  comes  on,  sooner  or  later,  but  sometimes 
only  after  years,  the  third  period,  called  period  of  inani- 
tion. Organic  disturbances  begin  to  appear,  the  breath 
is  foul,  the  stomach  and  abdomen  are  retracted,  there 
is  an  insuperable  constipation,  the  urine  is  scarce  and 
contains  little  urea  —  only  3  grammes  instead  of  30 
grammes  with  one  of  my  patients.  The  skin  becomes 
dry,  pulverulent,  and  in  certain  places,  as  on  the  wrists 
and  forehead,  cracked  and  covered  with  pimples.  The 
pulse  becomes  very  quick,  between  one  hundred  and 
one  hundred  and  twenty,  the  breathing  is  short  and 
hurried,  you  hear  cardiac  and  arterial  breaths.  Lastly, 
the  extenuation,  which  the  parents  best  observe,  makes 
surprising  progress.  It  is  a  clinical  fact  which  one 
must  well  remember,  that  weight  is  not  a  reliable 
sign  of  the  progress  of  the  disease ;  for,  after  a  rather 
great  decrease  at  the  outset,  it  is  only  at  the  end,  and 
often  too  late,  that  it  falls  suddenly. 

Matters  have  changed,  then.  The  patients  who  no 
longer  leave  their  beds  remain  in  a  semi-delirious,  semi- 
comatose  condition.  At  this  stage  they  behave  in 
two  different  ways ;  some  continue  to  be  delirious,  and, 
as  Charcot  said,  have  but  one  idea  left ;  namely,  to  re- 
fuse to  eat.  Others,  fortunately,  begin  to  be  frightened. 
That  was  what  Lasegue  expected ;  because  of  a  singu- 
lar therapeutic  dignity,  he  judged  that  the  physician 
was  not  justified  in  .doing  anything  before.  At  that 
moment  he  resumed  his  authority,  and  according  as 
the  patient  yielded  completely  or  partially  —  which 


The  Disturbances  of  Alimentation       233 

latter  case  was  the  more  frequent  —  he  cured  her 
more  or  less  completely.  In  fact,  the  hysterical  is 
privileged  in  this  respect.  You  know  that  the  dog 
cannot  be  called  back  to  life  when  it  has  lost  forty 
per  cent,  of  its  weight;  the  hysterical  can  still  be 
saved  at  fifty  and  above.  There  is  a  limit,  however. 
Out  of  his  eight  cases,  Lasegue  had  not  one  death; 
the  number  of  deaths  since  then  cannot  be  numbered. 
I  know  three,  for  my  part.  It  is  the  melancholy  period 
when  those  poor  girls  ask  to  eat  and  it  is  too  late.  It  is 
true  that  things  generally  take  another  turn,  and  an 
intercurrent  disease  comes  on,  broncho-pneumonia 
or  almost  phthisis,  which  simplifies  the  situation. 

Such  is  the  general  history  of  this  strange  mental 
disease.  Its  gravity,  its  frequency,  the  regularity  of 
its  evolution,  whatever  may  be  the  intelligence  of  the 
subject,  show  that  it  is  due  to  a  deep  psychological 
disturbance,  of  which  the  refusal  of  food  is  but  the  outer 
expression. 

II 

This  disturbance  of  thought  is  fairly  well  known  in 
its  details  and  evolution,  but  it  is  certainly  very  difficult 
to  interpret,  and  various  theories  of  anorexy  give  the 
preeminence  to  one  or  the  other  of  the  essential  phe- 
nomena. 

Lasegue,  and  later  on  Charcot,  gave  the  preeminence 
to  a  delirious  disturbance,  to  a  fixed  idea.  The  disease 
consists  essentially  in  an  idea  of  which  the  patient  is 
perfectly  conscious,  though  she  often  conceals  it,  and 
which  has  for  consequence  the  voluntary  and  calculated 


234      The  Major  Symptoms  of  Hysteria 

refusal  of  food.  Some  are  over  anxious  about  their 
stomach,  apprehend  the  pains  provoked  by  digestion, 
or  simply  fear  the  sensation  of  a  ball  in  their  oesophagus. 
Others  have  scruples,  regret  to  eat  the  flesh  of  living 
animals,  are  ashamed  to  eat  when  too  many  poor  people 
have  not  sufficient  food.  I  knew  a  girl  of  eighteen  who 
died  in  consequence  of  her  abhorrence  of  turnips, 
which  she  had  contracted  when  at  school.  To  the  end 
she  refused  to  eat  anything,  saying  that  everything  smelt 
of  turnips.  Very  often,  they  simply  have  the  common- 
place idea  of  suicide:  for  some  reason  or  other  these 
girls  make  up  their  minds  to  die  because  of  a  thwarted 
marriage,  a  reproach,  for  having  quarrelled  with  a  friend, 
etc.  And,  in  their  innocence,  they  adopt  starvation 
for  their  mode  of  death,  judging  it  to  be  a  simple,  clean, 
not  very  painful  process,  which  will  arouse  nobody's 
suspicion.  The  following  observation  of  Charcot  is 
famous:  while  undressing  a  patient  of  this  kind,  he 
found  that  she  wore  on  her  skin,  fastened  very  tight 
around  her  waist,  a  rose-coloured  ribbon.  He  obtained 
the  following  confidence;  the  ribbon  was  a  measure 
which  the  waist  was  not  to  exceed.  "I  prefer  dying 
of  hunger  to  becoming  big  as  mamma."  Coquetries 
of  this  kind  are  very  frequent;  one  of  my  patients 
refused  to  eat  for  fear  that,  during  her  digestion,  her 
face  should  grow  red  and  appear  less  pleasant  in  the 
eyes  of  a  professor  whose  lectures  she  attended  after 
her  meals. 

The  authors  who  have  observed  such  ideas  seem  to 
me  to  be  inclined  to  exaggerate  their  importance. 
This  is  what  certainly  happened  to  Charcot,  who  used 


The  Disturbances  of  Alimentation       235 

to  seek  everywhere  for  his  rose-coloured  ribbon  and 
the  idea  of  obesity.  I  believe  there  is  on  this  point  a 
diagnosis  to  be  made,  on  which  I  have  much  insisted 
in  the  first  volume  of  my  work  on  obsessions.  Refusals 
of  food  are  not  always  a  phenomenon  of  the  hysterical 
neurosis;  they  belong  at  least  as  often  to  the  psychas- 
thenic  neurosis.  It  is  in  the  latter  neurosis  that  fixed 
ideas  remain  alone  and  play  a  predominant  r61e  to  the 
end. 

These  patients  will  be  recognized  by  the  absence  of 
other  psychological  disturbances  associated  with  the 
fixed  idea.  In  particular,  they  have  no  real  anorexy; 
they  have  retained  the  feeling  of  hunger ;  and  they  often 
submit  to  veritable  tortures  in  order  not  to  yield  to 
their  need  of  food.  These  patients  make  it  a  point  of 
honour  not  to  yield,  at  least  before  others,  and  this 
accounts  for  an  odd  fact  often  indicated  in  their  history. 
After  having  all  day  refused  the  food  offered  to  them, 
they  get  up  at  night  secretly  and  steal  dirty  victuals, 
so  that  one  must  always  be  careful  to  leave  food  within 
their  reach.  As  they  have  no  real  loss  of  the  feeling 
of  hunger,  so  they  have  no  real  anesthesia,  either  in 
their  mouth  or  in  their  epigastrium;  lastly,  they  do 
not  present  that  excessive  need  of  movement,  the  im- 
portance of  which  I  have  already  indicated  in  real 
hysterical  anorexics.  In  the  latter,  in  fact,  the  fixed 
idea,  which  existed  at  the  outset,  it  is  true,  and  played  a 
certain  r61e  for  a  while,  becomes  complicated  with  very 
serious  phenomena,  as  the  loss  of  appetite,  the  anes- 
thesia of  various  organs,  certain  phenomena  of  system- 
atic paralysis  of  the  acts  relating  to  alimentation,  and 


236      The  Major  Symptoms  of  Hysteria 

the  great  motor  agitation.  I  believe  therefore  that  one 
should  distinguish  real  hysterical  anorexy  from  those 
refusals  to  eat  brought  on  by  various  obsessions,  and 
in  particular,  by  obsessions  of  scruples  in  various  psy- 
chasthenics. 

Therefore,  other  theories  tried  to  take  these  new 
phenomena  into  account,  and  this  is  done  in  particular 
by  a  theory  which  is  nowadays  pretty  widespread,  the 
theory  of  anorexy  through  the  anesthesia  of  the  stomach. 
Besides  the  anorexics  due  to  delirious  ideas  relating  to 
illness,  to  pudicity,  to  obesity,  it  has  been  asked  whether 
there  do  not  exist  anorexics  brought  about  by  disturb- 
ances of  the  organic  sensibility.  They  would  then 
justify  their  name  and  be  above  all  losses  of  the  sensa- 
tion of  hunger.  This  already  old  thesis,  which  was 
indicated  by  magnetizers,  such  as  Despine  in  1840,  has 
been  chiefly  developed  through  studies  on  metallo- 
therapy  carried  on  especially  by  Burcq,  1875-1882. 
Since  then,  it  has  been  systematized  and  exaggerated 
by  Sollier.  "Anesthesia,"  Burcq  once  said,  "exercises 
a  preponderant  influence  on  all  the  other  symptoms, 
in  particular  on  the  disturbances  of  alimentation  and 
on  the  secretions."  His  great  argument  was  that  he 
could  cause  these  anesthesias  to  vanish  through  the  use 
of  the  metallic  plates  and  armatures  he  had  contrived, 
and  that  he  then  saw  the  hysterical  phenomena,  anorexy 
in  particular,  disappear. 

There  is  much  truth  in  these  remarks.  First  of  all, 
we  must  recognize  in  anorexy,  when  already  well 
settled,  and  of  decidedly  hysterical  nature,  the  exis- 
tence of  numerous  anesthesias.  They  are  observed 


The  Disturbances  of  Alimentation       237 

in  the  mouth,  on  the  tongue,  on  the  internal  face  of 
the  cheeks,  in  the  oesophagus.  At  the  same  time  may 
be  noted  the  absolute  anesthesia  of  the  special  senses  of 
taste  and  smell.  You  know  that  the  patients,  especially 
at  the  outset  of  their  disease,  want  to  have  raw  aliments, 
and  ask  for  salt  and  vinegar  in  order  to  give  some  taste 
to  their  food;  and  that,  later  on,  they  complain  that 
they  are  given  sand  or  earth  to  eat.  You  also  know 
that  some  of  them  do  not  feel  the  food  in  their  mouths. 
It  is  not  rare  to  observe  at  the  same  time  the  anesthesia 
of  the  lower  part  of  the  digestive  tube,  of  the  anus,  and 
of  the  rectum.  The  anesthesia  of  the  stomach  itself 
and  of  the  small  intestine  is  the  more  difficult  to  estab- 
lish, as  the  sensibility  of  these  organs  is  commonly 
very  obtuse,  but  it  is  highly  probable.  Many  subjects 
do  not  feel  too  hot  or  too  cold  food  descend  into  their 
stomachs.  Moreover,  you  have  already  seen  a  very 
curious  law,  indicated  by  M.  Gilles  de  la  Tourette, 
namely,  that  often,  in  hysteria,  superficial  anesthesia 
of  the  skin  accompanies  the  anesthesia  of  the  organs 
placed  under  it.  Now,  in  hysterical  anesthesia,  a 
patch  of  cutaneous  insensibility  is  often  recognized, 
seated  just  in  the  epigastric  region.  It  is  probable, 
therefore,  that  the  mucous  membrane  of  the  stomach 
is  as  anesthetic  as  that  of  the  mouth. 

Do  these  various  anesthesias,  seated  in  all  the  parts 
of  the  digestive  tube,  play  a  rdle  in  the  disturbances  of 
the  functions  of  alimentation?  The  thing  seems  to 
me  very  likely.  The  fine  studies  of  physiologists,  in 
particular  those  of  M.  Pawlof,  have  shown  that  the 
saliva  secreted  by  a  dog  varies  with  the  object  presented 


23  8      The  Major  Symptoms  of  Hysteria 

to  him,  with  the  taste  and  smell  of  that  object.  They 
have  shown  that  the  secretions  of  the  stomach  and  of 
the  intestine  were  in  connection  with  the  sensation  of 
the  food  in  the  various  parts  of  the  digestive  tube. 
Since  these  patients  feel  neither  taste,  nor  smell,  nor 
any  excitation  of  the  mucous  membrane  of  their  stomachs, 
it  is  very  likely  that  their  digestion  will  be  disturbed.  A 
physician  even  tried  to  go  still  further.  You  know 
that  the  anesthesias  of  hystericals  are  mobile,  that  it  is 
possible,  through  various  processes,  to  cause  them  to 
disappear  and  to  reappear.  This  physician  thought 
he  recognized,  at  least  in  one  case,  that  the  secretion 
of  the  gastric  juice  was  very  different,  according  as  the 
subject  felt  or  did  not  feel  in  his  oesophagus  and  in  his 
stomach. 

From  these  remarks  results  a  new  conception  of  the 
disease.  It  is  the  gastric  anesthesia  which  is  here  the 
great  culprit.  While  the  sensation  of  the  movements 
and  of  the  secretions  of  the  stomach  is  the  starting  point 
of  the  feeling  of  appetite,  the  immobility  and  insensibility 
of  the  stomach  bring  on  complete  anorexy  and  all  the 
delirious  ideas,  which  are  considered  here  as  secondary. 

There  is  some  truth  in  this  conception,  but  it  does 
not  seem  to  me  to  be  complete.  First  of  all,  the  anes- 
thesia of  hystericals  is  never  complete,  and  does  not  do 
away  with  the  reflexes.  We  have  already  studied  this 
point.  If  food  is  introduced  by  force  with  the  sound 
into  the  stomach  of  the  most  anorexic  hysterical,  if  you 
prevent  immediate  vomiting,  you  will  recognize  that  the 
digestion,  perhaps  somewhat  slow  at  the  beginning, 
comes  to  be  completely  effected  and  in  the  most  normal 


The  Disturbances  of  Alimentation       239 

way.  This  M.  Henry  Francais  has  just  shown  again  in 
his  thesis  on  "  Apepsy,"  which  he  maintained  this  year. 
So  psychic  insensibility  does  not  play  here  a  consider- 
able material  part.  Supposing  the  anesthesia  of  the 
stomach  should  do  away  with  appetite,  it  would  not 
make  the  patients  incapable  either  of  eating  or  of  di- 
gesting. 

In  my  opinion,  an  exaggerated  importance  is  ascribed 
to  the  r61e  played  by  these  local  phenomena  of  the  mouth 
and  stomach  in  the  general  feeling  of  hunger  and  in  the 
function  of  alimentation.  Animals  that  have  been 
deprived  of  their  stomachs  still  try  to  feed.  We  do 
not  always  need  a  perfectly  marked  appetite  to  eat. 
We  often  accept  food  out  of  politeness,  in  mere  imitation 
of  others,  or  because  we  think  it  reasonable,  when  we 
do  not  really  wish  for  it.  In  a  word,  these  authors  are 
right  in  adding  more  elementary  and  more  general 
disturbances  to  the  fixed  ideas  of  hystericals.  They 
are  wrong  in  stopping  in  this  matter  at  the  sensibilities 
of  the  mouth  and  stomach. 

I  wish  a  more  thorough  investigation  might  be  made, 
in  this  connection,  of  a  phenomenon  that  is  as  yet  very 
imperfectly  elucidated ;  namely,  the  excessive  fondness 
for  physical  exercise  that  characterizes  a  whole  group 
of  anorexic  patients.  This  character  was  already 
noted  by  Lasegue.  It  is  well  indicated  in  a  short  and 
unfortunately  very  incomplete  article  of  Dr.  Wallet.1 
"The  patient,"  he  says,  "is  exceedingly  fond  of  long 
walks.  As  she  is  growing  thinner  with  enormous 

1  Wallet,  "  Deux  Cas  d'Anorexie  Hyste*rique,"  Nouvelle  Iconth 
graphic  de  la  Salpetrtire,  1892,  p.  276. 


240      The  Major  Symptoms  of  Hysteria 

rapidity,  they  are  forbidden  to  her.  She  then  begins 
to  walk,  from  morning  to  night,  up  and  down  the  little 
garden  of  the  house,  which  was  likewise  forbidden  to 
her.  Then  she  plays  all  day  at  shuttlecock.  It  is 
prescribed  that  she  stay  in  her  room;  there  she  gives 
herself  up  to  violent  gymnastic  exercises.  Even  in 
bed  she  goes  on  with  her  gambols  and  summersaults." 

For  my  part,  I  was  much  struck  with  this  odd  phe- 
nomenon, which  most  authors  merely  indicate,  without 
dwelling  upon  it.  One  of  my  patients,  Mu.,  has  had 
for  years  a  mania  of  walking  of  at  least  as  great  gravity 
as  her  mania  of  refusing  to  eat.  She  must  needs  go 
every  day  on  foot  as  far  as  the  Trocadero  and  the  Bois 
de  Boulogne.  The  carriage  has  only  the  right  to 
follow  her.  She  tires  the  persons  who  accompany  her. 
If  a  limit  is  fixed  of  two  hours'  fast  walking  a  day, 
she  makes  scenes  about  the  calculation  of  the  minutes. 
No  supplications  or  menaces  can  stop  her  walking,  any 
more  than  they  can  stop  her  inanition.  With  a  very 
singular  woman,  who  has  periodical  anorexics  conse- 
quent on  the  least  emotion,  the  need  of  walking  begins 
immediately  with  the  refusal  to  eat.  It  happens 
suddenly;  after  the  emotion,  she  refuses  to  return 
home,  as  well  as  to  dine.  This  character  is  at  least 
as  strange  as  the  first. 

The  first  explanation  of  this  fact  was  presented  by 
Lasegue  and  by  Charcot,  and  since  then  it  has  always 
been  repeated  without  hesitation.  These  patients  walk 
too  much  and  take  too  much  exercise  by  virtue  of  a 
piece  of  reasoning:  they  want  to  make  those  around 
them  believe  that  they  are  still  strong  and  robust,  in 


The  Disturbances  of  Alimentation       241 

order  not  to  be  compelled  to  eat  more.  I  confess 
this  explanation  does  not  satisfy  me.  Many  patients, 
who  spoke  to  me  sincerely  during  or  after  their  disease, 
have  assured  me  that  they  thought  nothing  of  the  kind. 
Moreover,  this  exaggerated  motion  is  to  be  found  in 
aged  patients  who  are  left  at  liberty  and  whose  alimen- 
tation nobody  watches  over. 

Another  curious  explanation  is  that  which  was  given 
by  M.  Wallet  in  1892.  The  patient  walks  in  order  to 
grow  thin,  in  order  to  compensate  with  the  exercise  he 
takes  the  alimentation  that  is  imposed  upon  him.  With 
this  explanation^  we  return  to  the  initial  idea  of  Charcot ; 
namely,  that  all  these  patients  want  to  grow  thin.  You 
know  that  it  is  not  true,  and  that  if  in  some  particular 
cases  this  exaggeration  of  motion  can  be  explained  by 
such  reasoning,  it  would  be  absurd  to  generalize  the 
explanation. 

I  believe  that  the  phenomenon  in  question  is  much 
more  important  and  serious  than  these  authors  thought. 
It  is  not  the  result  of  a  little  particular  imposition ;  it 
is  connected  with  a  very  general  disturbance.  This 
disturbance  first  comprises  the  suppression  of  the  feeling 
of  fatigue,  which  is  here  much  more  important,  in  my 
opinion,  than  the  anesthesia  of  the  stomach.  It  com- 
prises, besides,  something  that  is  very  little  known; 
namely,  a  general  excitation  to  physical  and  moral  ac- 
tivity, a  strange  feeling  of  happiness,  an  euphoria, 
according  to  the  medical  term,  which  are  certain  but 
very  little  studied  facts.  The  need  of  food  goes  with 
the  feeling  of  weakness  and  depression;  persons  de- 
pressed by  neurasthenia  are  great  eaters.  The  exal- 


The  Major  Symptoms  of  Hysteria 

tation  of  the  strength,  the  feeling  of  euphoria,  as  it  is 
known  in  the  ecstatic  saints,  for  instance,  does  away 
with  the  need  of  eating.  Our  hysterical  anorexy  is  to 
be  traced  to  much  deeper  sources  than  was  supposed. 
This  is  how  I  propose  to  you  to  represent  it  to  our- 
selves, without,  however,  pretending  to  explain  it.  The 
function  of  alimentation,  if  we  consider  it  on  its  psy- 
chological side,  is  one  of  the  most  considerable  systems  of 
thoughts  that  exist  in  the  brain  of  an  animal.  It  com- 
prises fundamental  phenomena,  such  as  the  feeling  of 
weakness,  of  depression,  and  the  fear  of  death.  Besides, 
it  comprises  numberless  secondary  phenomena,  such  as 
the  sensations  and  motions  connected  with  all  the  parts 
of  the  organism  that  play  a  r61e  in  alimentation,  from 
the  hands,  lips,  and  tongue  to  the  rectum  and  anus; 
lastly,  it  also  comprises  phenomena  of  improvement, 
as  the  images  of  pleasant  aliments,  the  habits  of  eating 
cleanly,  and  the  mixture  of  certain  social  phenomena 
that  usually  complicate  our  alimentation.  There  is  in 
the  hysterical  a  dissociation  of  this  system,  which  may 
totally  or  partially  withdraw  from  consciousness.  In 
complete  anorexy,  you  will  find  the  loss  of  all  the  ele- 
ments I  have  just  described,  the  loss  of  the  sensation  of 
weakness,  replaced  by  a  pathological  euphoria,  the  loss 
of  the  sensations  of  the  organs,  but  also,  more  than  is 
generally  believed,  the  loss  of  the  movements.  These 
patients  can  no  longer  cleanly  convey  their  food  to  their 
mouths,  they  can  no  longer  masticate,  and  above  all, 
they  can  no  longer  swallow,  nor  can  they  go  to  stool. 
There  is,  besides,  a  phenomenon  which  has  not  been 
much  noticed  and  which  consists  in  losses  of  the  social 


The  Disturbances  of  Alimentation       243 

ideas  of  alimentation.  Marceline  was  very  amusing 
when  she  explained  to  me  how  ridiculous  she  thought 
the  act  of  eating,  how  much  she  wondered  to  see  people 
gather  for  this  dirty  operation.  Hysterical  anorexy  is, 
at  bottom,  a  great  amnesia  and  a  great  paralysis.  Ali- 
mentation has  become,  as  it  were,  a  somnambulistic 
phenomenon  which  can  only  be  effected  in  the  second 
or  somnambulistic  state,  as  happened  with  the  last 
patient.  This  phenomenon  is  lost  to  the  normal  and 
waking  consciousness. 

Ill 

Before  concluding  this  lecture,  I  should  like  rapidly 
to  add  a  few  details,  which  it  is  necessary  that  you  should 
know,  but  to  dwell  on  which  would  take  too  long. 
The  dissociation  of  which  I  have  just  spoken  to  you 
may  bear  on  all  the  elements  of  which  the  function  is 
composed,  and  suppress  them  separately.  You  have  then 
kinds  of  paralyses  or  amnesias,  as  you  choose,  which 
may  be  connected  with  all  sorts  of  organs.  It  is  need- 
less to  enumerate  them;  you  have  only  to  follow  the 
organs  themselves.  The  hysterical  patient  may  lose 
the  functions  of  the  lips  in  alimentation,  as  she  lost  them 
in  speech.  She  may  lose  the  functions  of  the  tongue 
or  those  of  the  teeth. 

Grant  a  little  more  attention  to  the  functions  of 
deglutition  of  the  pharynx.  Many  of  these  patients  can 
no  longer  swallow,  and  they  should  not  be  confounded 
with  psychasthenics,  who  have  the  phobia  of  deglu- 
tition. Some  of  these  subjects  cannot  make  their  food 


244      The  Major  Symptoms  of  Hysteria 

pass  from  their  oesophagus  into  their  stomach.  I  am 
attending  an  old  hysterical  lady,  and  do  you  know  what 
my  first  care  must  be  when  I  see  her  after  her  lunch? 
It  is  to  make  her  swallow  her  lunch,  which  she  still 
has  in  her  oesophagus.  I  am  sure  that  the  amnesia  of 
defecation  plays  a  r6le  in  many  obstinate  constipations. 

What  happens  for  the  intestine  is  still  more  important 
and  frequent  for  the  bladder.  You  know  that  hysteri- 
cals  may  lose  all  the  functions  of  the  bladder  or  only 
some  part  or  other  of  them.  Nothing  is  more  impor- 
tant for  a  physician  than  to  know  thoroughly  the  neuro- 
pathic disturbances  of  micturition ;  he  can  render  many 
services  to  unfortunate  people  and  avoid  many  guilty 
mistakes.  How  many  operations  are  performed  on 
young  women  under  pretence  that  their  urethra  is 
either  too  big  or  too  narrow,  when  their  urethra  has 
nothing  to  do  with  their  urinary  awkwardness.  They 
can  no  longer  either  begin  the  micturition,  or  stop  it, 
or  control  it,  and  you  have  varieties  of  incontinence  or 
retention  that  may  become  exceedingly  complicated. 

This  rapid  review  of  the  dissociation  of  the  functions 
of  alimentation  confirms  my  general  studies  on  hysteri- 
cal paralysis  and  amnesias,  and  gives  us  the  plan  of 
our  next  lecture  on  respiratory  disturbances. 


LECTURE  XII 

THE  TICS  OF  RESPIRATION  AND 
ALIMENTATION 

Respiratory  paralyses  —  The  problem  of  hysterical  asphyxia 

—  Respiratory  anesthesia  —  Respiratory  disorders  —  The 
rhythm   0}  Cheyne-Stokes  —  The   paralysis   of  the  dia- 
phragm with  alternating  see-saw  respiration  —  Respiratory 
agitations  —  Polypnoea  —  Inspiration    tics  —  The    sigh, 
yawn,  hiccough — Aerophagia  — Expiratory  tics  — Hyster- 
ical cough  —  Laughter  —  Hysterical  bark  —  Complex  tics 

—  The  meteorism  of  the  abdomen  —  The  tics  of  alimenta- 
tion —  Bulimia  —  Polydipsia  and  polyuria  —  The  spasms 
of  the  jaws,  cheeks,  pharynx  —  The  tic  of  eructation  —  The 
tic  of  regurgitation  —  The  tics  of  aspiration  —  Hysterical 
vomiting  —  The  vomiting  of  blood 

WE  have  to  repeat  in  regard  to  respiration  a  study 
analogous  to  that  which  we  devoted  to  the  functions 
of  alimentation ;  the  phenomena  are  about  of  the  same 
kind,  though  they  are  of  less  gravity.  On  the  other 
hand,  they  are  of  infinite  variety,  and  we  might  dwell 
indefinitely  on  the  apnceas,  dyspnoeas,  suffocations, 
respiratory  disturbances,  on  the  varied  respiratory 
paralyses,  on  the  innumerable  tics,  polypncea,  yawn, 
sigh,  sob,  hiccough,  cough,  sneeze,  bark,  shakes  0}  the 
abdomen,  meteorism,  without  counting  the  tics  of  the 
organs  of  alimentation,  which  I  should  like  to  place  by 
the  side  of  the  latter,  namely,  eructation,  regurgitation, 

245 


246      The  Major  Symptoms  of  Hysteria 

borborygms,  vomitings,  etc.  Do  not  be  too  frightened ; 
we  shall  be  brief  on  all  this,  for,  the  general  rules  once 
known,  these  various  phenomena  are  always  similar 
to  one  another. 


Let  us  first  speak  of  the  respiratory  paralyses,  and, 
to  illustrate  our  teaching,  let  us  at  once  place  a  very 
curious  example  before  your  eyes.  The  case  was  pub- 
lished a  few  years  ago  by  M.  Lermoyez,  a  distinguished 
specialist  in  diseases  of  the  nose  and  larynx.1  Being  very 
interesting  as  regards  the  theory  of  hysteria,  and  being 
described  simply,  without  any  preconceived  idea,  by 
a  physician  who  has  not  made  a  specialty  of  the  diseases 
of  the  nervous  system,  and  who  is  not  engaged  in  the 
quarrels  of  our  schools,  this  case  should  have  attracted 
the  attention  of  scientists  much  more  than  it  did. 

A  girl  of  about  twenty  was  taken  to  M.  Lermoyez 
because  her  nose  was  obstructed  by  adenoid  vegeta- 
tions, which  disturbed  her  respiration  and  attention. 
The  vegetations  were  not  very  big,  and  the  operation 
was  effected  without  any  difficulty.  But  it  was  noticed 
that  the  girl  did  not  breathe  better  than  before,  that, 
in  particular,  she  was  obliged  to  keep  her  mouth  open, 
which  dried  her  tongue  and  lips.  M.  Lermoyez  thought 
the  nose  was  still  obstructed;  so  he  examined  it  mi- 
nutely, but  he  discovered  nothing,  for  the  respiratory 
channels  were  wide  open.  Wishing  to  prove  to  the 

1  M.  Lermoyez,  "  Insuffisance  Nasale  Hyst6rique,"  Societe  Midicale 
des  Hdpitaux  de  Paris,  January,  1899.  La  Presse  Medicale,  January 
25,  1890. 

\ 


Tics  of  Respiration  and  Alimentation     247 

girl  that  she  breathed  very  well  through  her  nose,  that 
she  kept  her  mouth  open  needlessly  and  out  of  habit, 
he  applied  his  hand  on  her  mouth,  with  the  idea  that 
she  would  simply  breathe  through  her  nose.  To  his 
great  surprise,  it  was  not  so.  There  was  no  breath 
through  the  nostrils,  the  patient  writhed  as  if  she  were 
choking,  and,  as  he  insisted  on  her  trying  again,  while  she 
was  being  held  fast,  her  face  and  ears  turned  blue.  In 
a  word,  this  girl  suffocated  when  you  shut  her  mouth, 
while  leaving  her  nose  open.  There  was,  however,  no 
obstacle  at  any  point,  there  was  only  a  singular  disturb- 
ance of  the  nervous  system,  an  incapacity  of  effecting 
the  respiratory  motion,  of  moving  her  chest  in  the  least 
as  soon  as  the  mouth  was  shut.  As  M.  Lermoyez  very 
rightly  said,  this  girl  had  forgotten  how  one  manages 
to  breathe  through  one's  nose.  Can  a  finer  confir- 
mation be  found  of  our  teaching  on  functional  paraly- 
ses and  amnesias?  Have  we  not  there  a  pretty  dis- 
sociation of  the  respiratory  function,  or  at  least  of  one 
of  the  parts  of  the  respiratory  function?  This  exam- 
ple at  once  shows  you  that  we  shall  find  the  same 
problems  in  the  study  of  respiration. 

Yet  it  is  incontestable  that  we  cannot  begin  with  so 
important  and  so  definite  a  disturbance  as  anorexy. 
The  latter  was,  as  we  saw,  the  suppression,  the  dis- 
sociation of  the  whole  of  alimentation,  going  as  far 
as  inanition  and  death.  It  was  the  great  functional 
paralysis.  Is  there  a  corresponding  absence  of  respira- 
tion, a  corresponding  asphyxia  suppressing  all  respira- 
tion and  going  as  far  as  death  ? 

The  point  is  moot ;  you  may  see  the  opinions  for  and 


248      The  Major  Symptoms  of  Hysteria 

against  it  in  the  book  of  M.  Gilles  de  la  Tourette.1 
For  my  part,  I  hesitate  to  admit  that  it  can  be  true.  I 
have  seen  several  persons  die  of  hunger ;  I  have  not  yet 
seen  any  one  die  of  suffocation.  Hysterical  asphyxia, 
resulting  from  various  disturbances  in  the  respiratory 
mechanism,  does  not  seem  to  us  to  be  capable,  in  gen- 
eral, of  bringing  about  death.  A  moment  comes  when 
asphyxia  brings  on  fainting ;  that  is,  the  arrest  of  the 
higher  functions  of  the  brain,  and  the  respiration,  being 
no  longer  impeded  by  these  higher  functions,  is  restored 
owing  to  the  automatism  of  the  bulb. 

Therein  lies,  in  fact,  the  difference  I  indicate  to  you 
between  the  alimentary  and  respiratory  disturbances. 
Alimentation,  or  at  least  the  mechanical  part  of  it,  con- 
sisting in  the  prehension  of  aliments,  is  entirely  a  con- 
scious, voluntary  function.  Even  if  we  die  of  hunger, 
if  we  are  in  a  swoon  brought  on  by  inanition,  no  bulbar 
mechanism  will  cause  us  to  eat.  Whereas  respiration 
is  not  entirely  a  conscious  and  voluntary  function. 
Consciousness  may  disturb  it  greatly,  no  doubt;  we 
shall  see  how  many  foolish  things  it  may  do;  but, 
happily  for  us,  there  is  outside  our  consciousness  a 
fundamental  mechanism,  which  is  the  safeguard  of 
our  hystericals.  This  difference  between  hysterical 
anorexy  and  hysterical  asphyxia  as  regards  danger  is 
still  another  fact  to  be  pointed  out  in  order  to  justify 
our  mental  interpretation  of  the  disease. 

However  it  may  be,  there  exist  hysterical  disturb- 
ances of  respiration,  which  fact  we  understand  very 
well  now  we  know  the  influence  of  the  brain  on 

1  Gilles  de  la  Tourette,  "Traite*  de  la  Hysteric,"  1895,  II,  p.  124. 


Tics  of  Respiration  and  Alimentation     249 

this  function.  Flourens  in  1842  connected  respiration 
entirely  with  the  bulb,  but  since  the  works  of  Coste  in 
1861,  of  Danilewsky  in  1875,  of  Le"pine,  of  Richet,  of 
Franck,  of  Pachon,  and  especially  of  Mosso,  we  know 
very  well  that  there  is  a  cerebral  respiration.  When 
the  brain  is  benumbed,  the  respiration  decreases  and 
is  reduced;  it  seems  that  in  total  respiration  there  is 
a  part  of  superfluous  respiration  or  respiration  of  luxury, 
as  Mosso  called  it,  which  depends  on  cerebral  activity. 
It  is  this  respiration  of  luxury  that  hystericals  can  mod- 
ify in  a  thousand  ways. 

We  first  find  disturbances  of  the  respiratory  sensibility, 
which,  of  course,  play  a  fairly  important  part  in  the 
evolution  of  the  accidents,  for  you  know  that  every 
loss  of  a  function  or  every  paralysis  is  accompanied 
by  an  unconsciousness,  relative  to  the  special  sensations 
that  play  a  part  in  the  function ;  that  is  to  say,  with  a 
systematic  anesthesia.  You  will  often  find  more  or 
less  diffuse  anesthesias  distributed  over  the  organs  of 
respiration.  The  nose  is  very  often  insensible,  and  the 
absence  of  the  perception  of  odours  —  anosmia — accom- 
panies the  respiratory  disturbances  as  well  as  the  dis- 
turbances of  alimentation.  The  pharynx  is  very  often 
insensible.  You  know  that  formerly  Chairon  wanted 
to  make  this  insensibility,  and  the  loss  of  the  pharyn- 
geal  reflex  to  tickling,  a  symptom  characteristic  of 
every  hysteria.  This  is  very  exaggerated,  though  the 
fact  is  frequent,  since  it  accompanies  the  disturbances 
of  alimentation  and  those  of  respiration.  You  will 
find  disturbances  of  sensibility  distributed  over  the 
thorax  and  abdomen. 


250      The  Major  Symptoms  of  Hysteria 

What  is  more  interesting,  you  will  be  able,  in  certain 
cases,  to  recognize  a  very  special  anesthesia  relative 
to  respiration  itself.  We  feel  our  respiration,  and, 
above  all,  we  feel  the  need  of  breathing.  M.  Bloch 
in  1897  invented  a  curious  apparatus  for  measuring 
this  respiratory  sensibility.  The  subject  is  obliged 
to  breathe  through  a  tube  the  end  of  which  is  closed 
by  a  window  of  calculated  dimensions.  A  screw 
allows  you  gradually  to  reduce  the  dimensions  of  the 
window,  and  the  subject,  whose  eyes  are  shut,  must 
indicate  at  what  moment  he  feels  a  difficulty  in  breath- 
ing. 

The  figures  obtained  vary  pretty  much  with  the  sub- 
ject, the  hour  of  the  day,  and  the  movements  the  sub- 
ject has  just  made,  but  I  have  been  able  to  observe  that 
in  hystericals  the  figures  are  often  very  different  and 
infinitely  smaller.  The  patient  indicates  only  very  late 
the  need  to  breathe,  much  later  than  a  normal  indi- 
vidual would  do,  when  she  is  already  half  suffocated. 
This  phenomenon  shows  a  special  unconsciousness  of 
the  respiratory  need,  which  is  to  a  certain  extent  com- 
parable to  anorexy ;  that  is  to  say,  to  the  unconsciousness 
of  hunger. 

These  disturbances  of  the  sensibility  are  accompanied 
with  motor  disturbances  of  which  the  subjects  are  more 
or  less  conscious.  They  can  no  longer  breathe  volun- 
tarily, though  they  do  not  arrive  at  total  asphyxia  for 
the  physiological  reasons  I  have  pointed  out.  They 
can  no  longer  add  to  their  respiration  that  luxury  to 
which  we  are  accustomed.  The  subject  complains  of 
feeling  oppressed,  of  feeling  contracted  in  her  neck,  in 


Tics  of  Respiration  and  Alimentation     251 

her  chest,  of  suffocating,  of  not  being  able  to  make  air 
enter  her  chest.  Sometimes  these  phenomena  are  conse- 
quent on  accidents  bearing  on  the  respiratory  organs,  — 
we  have  just  seen  this  in  the  case  of  Lermoyez,  —  and  the 
least  cold  in  the  head  may  cause  similar  phenomena  in 
the  patient  in  question.  Sometimes  they  are  consequent 
on  any  emotion  whatever,  disturbing  the  respiration, 
which  the  subject  cannot  restore.  In  many  cases,  the 
respiration,  abnormal  during  the  waking  state,  very 
quickly  becomes  normal  again  during  the  somnam- 
bulistic state  or  the  periods  of  absent-mindedness.  The 
accident  is  quite  conformable  to  the  rules  that  apply  to 
paralyses. 

You  should  not  believe,  however,  that  these  facts  are 
connected  with  real  paralyses  of  such  or  such  an  organ 
of  respiration.  The  paralysis  is  less  definite  here  than 
in  alimentary  disturbances,  again  for  the  same  reason. 
A  most  interesting  phenomenon  which  I  have  very  often 
recognized  in  this  connection  is  a  respiratory  disorder, 
an  absence  of  regularity  and  harmony.  Respiration 
depends  on  complex  organs,  the  nose,  the  pharynx,  the 
glottis,  the  thoracic  cavity,  the  diaphragm;  it  cannot 
be  effected  correctly  if  everything  does  not  work  at  the 
same  time  and  in  the  same  direction.  It  is  useless  to 
dilate  your  thorax  if  you  shut  your  glottis  or  swell  your 
diaphragm.  This  is  what  our  patients  do.  The  efforts 
they  make  in  their  various  organs  are  contradictory,  and 
that  is  the  reason  why  they  make  only  very  little  air 
enter  their  chest,  in  spite  of  apparently  considerable 
efforts.  Bear  this  detail  in  mind ;  you  must  not  think 
that  people  breathe  very  much  when  they  agitate  their 


252      The   Major  Symptoms  of  Hysteria 

chest  very  much.  Spirometric  measures  show  us  that 
hystericals  breathe  very  little  in  reality,  in  spite  of  great 
apparent  heavings  of  their  thorax  and  abdomen.  Their 
respiratory  disturbance  is  less  a  paralysis  proper  than  a 
want  of  synergy.  This  is  also  interesting  for  the  com- 
prehension of  their  paralyses,  which  are,  as  I  have  told 
you,  paralyses  of  a  system.  One  may  no  longer  be 
able  to  ride  a  bicycle  without  having  any  apparent 
paralysis  of  the  legs. 

In  certain  cases,  however,  the  respiratory  disturbance 
may  assume  more  determinate  forms,  which  have  greater 
resemblance  with  known  paralyses ;  but  these  facts  are 
rare  and  still  discussed.  I  merely  indicate  to  you  the 
problem.  I,  myself,  communicated  to  the  Congress  of 
Psychology,  held  in  Paris  in  1900,  a  fact  which  is  very 
important  in  my  opinion,  namely  the  appearance  of  the 
rhythm  of  Cheyne-Stokes  in  hysteria.1 

You  know,  that  about  1816,  Cheyne  of  Dublin  and 
Stokes  described  a  certain  quite  special  irregularity  of 
respiration,  which,  to  their  mind,  was  characteristic  of 
the  most  serious  states.  As  you  see  on  this  table  (Figure 
16),  this  rhythm  is  characterized  by  respiratory  pauses ; 
there  is  a  series  of  ten  to  fifteen  quick  breaths,  then  an 
arrest  of  the  respiration  which  may  last  long,  half  a 
minute  in  some  cases ;  then  the  active  respiratory  series 
begins  again.  At  the  outset,  this  phenomenon  was  only 
established  in  cerebral  apoplexy,  in  most  forms  of  agony, 

1 F.  Raymond  et  Pierre  Janet,  "  Un  cas  du  rhythme  de  Cheyne- 
Stokes  dans  Physte'rie,  influence  de  I'activite"  ce're'brale  sur  la  respira- 
tion," Comptes  rendus  du  IVme  congres  international  de  psychologic > 
tenu  k  Paris  en  Aout  1900;  1901,  p.  524. 


253 


254      The  Major  Symptoms  of  Hysteria 

in  certain  varieties  of  cerebral  tumours.  Later  on,  it 
was  also  found  in  typhoid  fever,  in  uraemia,  in  various 
intoxications.  M.  Mosso  was  the  first  to  generalize 
this  respiratory  rhythm  singularly;  he  showed  that  it 
existed  in  simple  natural  sleep  when  profound,  and,  in 
general,  in  all  states  of  general  numbness. 

At  a  time  when  I  used  to  take  systematically  and  with 
some  exaggeration  the  graphic  of  the  respiration  of  all 
the  hystericals  I  attended,  I  was  very  much  astonished 
to  find  with  one  of  them  a  graphic  which  exactly  pre- 
sented the  rhythm  of  Cheyne-Stokes.  I  refer  you  to 
my  article  if  you  wish  to  see  studies  which  are  not  with- 
out interest  on  the  modifications  of  this  rhythm.  This 
patient  was  always  in  a  state  of  absent-mindedness  and 
revery.  When  her  attention  was  attracted  through 
any  process,  her  respiration  changed  and  became  again 
nearly  normal.  It  is  the  same  in  the  other  cases  of 
Cheyne-Stokes  that  I  found  in  hystericals.  This  respi- 
ration exists  in  subjects  who  are  in  a  condition  of  half- 
sleep  and  who  are  incapable  of  any  attention.  It 
vanishes  when  the  subject  is  more  awake  and  more 
active.  These  observations  are  interesting  in  that  they 
show  the  rdle  of  respiration  in  attention.  They  are  also 
important  for  the  theory  of  hysteria,  for  they  show  us 
here  the  disturbance  of  a  function,  that  of  attentive 
respiration,  which  is  not  a  function  known  to  the  sub- 
ject and  which  consequently  cannot  be  disturbed  through 
preconceived  ideas. 

In  the  same  order  of  ideas,  I  wish  to  indicate  to  you, 
rather  as  a  curiosity,  for  this  time  I  have  seen  only  one 
case  of  the  phenomenon,  a  paralysis  of  the  diaphragm 


Tics  of  Respiration  and  Alimentation      255 

with  alternating  see-saw  respiration.  You  know  that, 
in  normal  respiration,  the  diaphragm  falls  when  the 
thorax  rises,  actively  forces  down  the  intestines,  and 
consequently  swells  the  abdomen  during  each  inspira- 
tion. If  the  diaphragm  is  paralyzed,  it  cannot  perform 


FIG.  17.  —  Graphic  of  the  respiration  in  a  case  of  polypnoea,  80  respira- 
tions in  a  minute,  and  of  discordant  respiration.  The  signs  have  the 
same  meaning  as  in  the  preceding  figure. 

this  active  movement;  it  floats  like  an  inert  veil,  and 
allows  itself  to  be  drawn  up  during  each  thoracic  in- 
spiration ;  the  abdomen  hollows  inwards  instead  of 
swelling  when  the  thorax  dilates :  that  is  what  is  called 
see-saw  respiration.  It  was  formerly  considered  as  very 
dangerous  and  incompatible  with  life.  Briquet  already 


256      The  Major  Symptoms  of  Hysteria 

vaguely  indicated  an  instance  of  it  in  a  case  of  hysteria. 
I  have  very  accurately  described  an  observation  of  this 
phenomenon  relating  to  the  girl  whose  whole  trunk  was 
paralyzed  in  consequence  of  a  fall  into  a  well.1  You 
see  in  this  graphic  (Figures  17  and  18)  that  the  respira- 
tion is  very  quick,  80  respirations  in  a  minute,  and 
that  the  graphic  of  the  thoracic  respiration,  T,  and  of 


FIG.  18.  —  Another  graphic  of  the  same  respiration  taken  with  increased 
speed  of  the  registering  cylinder,  in  order  to  put  into  evidence  the  dis- 
cordance between  the  thoracic  (7^)  and  the  abdominal  (A)  respirations. 

the  abdominal  respiration,  A,  are  not  parallel,  but  dis- 
cordant. The  abdomen  hollows  inward  instead  of 
swelling  when  the  thorax  dilates,  which  I  have  pointed 
out  as  the  sign  of  the  paralysis  of  the  diaphragm.  The 
young  patient  of  this  case  had  undoubtedly  a  number 
of  hysterical  accidents,  and  this  phenomenon  was,  I 
think,  of  the  same  kind.  But  it  is,  I  own,  a  phenomenon 

1 "  Ndvroses  et  Idees  fixes,"  I,  p.  329;  II,  p.  414. 


Tics  of  Respiration  and  Alimentation     257 

whose  presence  in  hysterics  is  still  open  to  discussion. 
If  this  presence  is  confirmed,  we  shall  be  obliged  to 
admit  more  profound,  older  functions  relative  to  the 
movement  of  the  diaphragm,  which  may  be  troubled  in 
certain  serious  forms  of  hysteria  as  old  functions  are 
disturbed  in  hemiplegy  and  hemianopsia. 

II 

To  those  paralyses  of  the  respiratory  function  are 
added,  as  is  always  the  case,  and  according  to  the  rule 
we  know,  automatic  agitations.  The  functions  are  never 
entirely  lost  in  hysteria ;  they  are  emancipated.  In  this 
state  they  are  performed  in  a  more  or  less  absurd  man- 
ner, without  the  will  of  the  subject.  As  there  are  in  the 
respiratory  function  a  quantity  of  small  distinct  func- 
tions, each  of  them  may  emancipate  itself  separately 
and  give  rise  to  very  varied  tics. 

Let  us  put  in  the  first  rank  the  exaggeration  of  total 
respiration,  polypncea.  Here  is  a  fine  case.  A  is  a 
man  of  thirty,  a  foreman  in  a  seaport.  One  day  he 
was  commanding  some  workmen  who  were  working  a 
capstan  in  order  to  raise  a  tall  mast.  He  saw  a  rope 
break  and  the  mast  incline,  and  fancied  that  it  was 
falling  on  his  workmen,  which  caused  him  to  utter  loud 
cries.  No  accident  occurred,  but  he  was  so  fatigued 
with  this  emotion  that  he  was  obliged  to  return  home. 
The  next  day  it  was  noticed  that  he  breathed  in  an  odd 
way;  the  respiratory  disturbance  grew  little  by  little 
and  turned  to  a  great  polypncea  which  lasted  several 
months.  He  kept  on  breathing  with  unheard-of  quick- 


258      The   Major  Symptoms  of  Hysteria 


ness  and  force  ;  his  chest  heaved  very  strongly  and  very 
quickly  without  any  interruption.  He  had  88  then 
97  respirations  a  minute,  instead  of  the  normal  18 
(Figure  19).  This  formidable  respiration  exhausted  him, 
threw  him  into  a  perspiration,  and  above  all  did  not 
leave  him  the  least  freedom  of  mind.  He  sat  motion- 
less on  his  chair,  thinking  of  nothing,  doing  nothing  but 
•breathe.  Notice  also  tnat  continual  paralle1  of  the  dis- 


FIG.  19.  —  Graphic  of  the  respiration  in  the  case  of  polypncea  of  A. 

turbances  of  respiration  and  those  of  attention.  As 
soon  as  he  was  hypnotized  the  respiration  became  calm, 
and  he  was  very  quickly  cured  through  this  process. 

But  note  in  passing  a  fact  to  which  we  shall  revert 
later  on:  our  patient  remained  cured  for  two  years, 
then  he  lost  a  little  daughter,  and  do  you  know  what 
disturbance  he  was  affected  with  in  consequence  of  this 
grief?  Was  it  a  somnambulism  or  a  crisis,  as  was  the 
case  in  so  many  of  the  patients  we  passed  in  review  f 


Tics  of  Respiration  and  Alimentation     259 

No,  it  was  the  same  polypncea  which  began  again  and 
had  to  be  cured  through  the  same  process.  By  the  side 
of  this  case  might  be  put  that  of  a  girl  who  breathed 
seventy  times  a  minute  after  suffering  an  attempt  at 
rape,  and  many  of  the  same  kind. 

After  those  exaggerations  of  the  total  respiration,  let 
us  rapidly  enumerate  the  exaggerations  of  details,  the 
tics  bearing  on  such  or  such  a  particular  function.  Let 
us  first  consider  inspiration  tics,  exaggerated  inspiration, 
which  is  connected  with  a  certain  degree  of  dyspnoea, 
and  will  assume  the  form  of  continual  sighs.  When  a 
little  stronger,  it  will  be  a  sob,  then  a  yawn.  You  know 
what  importance  was  formerly  attributed  to  the  hysteri- 
cal yawn,  which  was  thought  very  amusing.  Nothing,  in 
fact,  is  more  singular  than  those  poor  girls  who,  all  day 
long,  and  two  or  three  times  a  minute,  yawn  till  they 
almost  disjoint  their  jaws.  It  is  one  of  the  phenomena 
in  which  the  imitative  contagion  is  best  exhibited ;  it  is 
also  a  phenomenon  in  relation  with  the  disturbances  of 
alimentation. 

It  is  the  same  with  the  last  inspiratory  tic,  the  hiccough, 
which  is  also  very  frequent.  The  hiccough  is  nothing 
but  a  very  rapid  inspiration  with  a  certain  degree  of 
spasm  of  the  glottis.  The  air  cannot  reenter  quickly 
enough,  because  the  inspiration  is  too  rapid  and  also 
because  the  glottis  is  a  little  closed ;  this  results  first  in 
a  certain  characteristic  noise,  and  also  in  a  certain 
thoracic  vacuum,  which  causes  an  aspiration  in  all  the 
organs.  You  can  see  this  fact  in  the  graphic  of  hiccough 
(Figure  20) :  when  the  hiccough  appears  at  the  beginning 
of  each  inspiration,  the  abdomen  is  aspirated  and  the 


260     The  Major  Symptoms  of  Hysteria 

graphics  of  both  respirations,  thoracic  T  and  abdominal 
A,  are  momentarily  discordant.1 

This  will  presently  play  a  great  part  in  the  phe- 
nomenon of  aerophagia,  with  patients  who  swallow  air, 
and  in  vomition.  Let  us  only  remark  that  the  hiccough 
is  one  of  the  most  frequent  phenomena.  When  looking 


FIG.  20.  — Graphic  ot  respiration  in  a  case  of  continuous  hicough,    A  hic- 
cough in  each  respiration  at  the  beginning  of  the  inspiration. 

over  my  notes  to  prepare  this  course  of  lectures,  I 
counted  twenty-nine  great  observations  of  hysterical 
hiccough  that  had  lasted  for  months  together. 

Among  the  expiratory  tics,  we  shall  first  range  the 
hysterical  cough,  that  little  phenomenon  so  frequent  at 
the  outset  of  the  disease.  There  are,  in  this  connection, 
clinical  observations  on  the  evolution,  which  are  facts 
of  experience  and  cannot  very  well  be  accounted  for. 

1  "  Nevroses  et  Idees  fixes,"  II,  Observation  100,  p.  360. 


Tics  of  Respiration  and  Alimentation     261 

Thus  the  hysterical  hiccough  is,  to  my  mind,  a  rather  seri- 
ous phenomenon  of  bad  prognosis.  It  points  to  a  great 
hysteria;  the  hysterical  cough,  which  is  almost  like  it, 
is  a  more  commonplace  and  less  serious  phenomenon. 
Almost  every  girl  has  had  an  irrepressible  cough  in  con- 
sequence of  a  certain  cough,  of  efforts  in  singing,  or  of 
fits  of  bashfulness.  When  the  phenomenon  is  isolated, 
it  is  very  difficult,  in  my  opinion,  to  say  whether  we 
have  to  deal  with  incipient  hysteria  or  with  a  mere 
psychasthenic  tic.  As  always,  pay  attention  to  the 
state  of  the  sensibility,  to  the  degree  of  the  unconscious- 
ness, and  to  the  effects  of  distraction. 

One  degree  further:  you  have  hysterical  laughter, 
those  interminable  crises  of  laughter  which  develop 
for  hours  together  like  real  fits  of  hysterics.  You  know 
the  psychological  problem  of  laughter,  and  are  aware 
that  this  phenomenon,  apparently  so  amusing,  is  a  tor- 
turing problem  for  the  unfortunate  scientists.  You 
should  not  fancy  that  laughter  is  always  the  expression 
of  joy.  Certain  hysterical  laughters  are  of  this  kind. 
Thus  a  girl  of  bad  morals  had  undergone  a  little  surgical 
operation  for  which  she  had  been  half  chloroformed, 
but,  during  this  trifling  operation,  young  students  of 
the  hospital,  who  surrounded  her,  had  kept  joking  her 
and  making  her  laugh.  Probably  under  the  influence 
of  the  chloroform,  this  laughter  was  transformed  into 
an  independent  automatic  phenomenon,  and  persisted 
as  a  tic.1  But,  in  other  cases,  laughter  accompanies 
pain;  it  accompanies  nervous  exhaustion  and  is  to  be 
observed  in  great  delirious  attacks.  It  is  probably  a 

1  "  NeVroses  et  Ide"es  fixes,"  II,  Observation  98,  p.  352. 


262      The  Major  Symptoms  of  Hysteria 

phenomenon  of  derivation  of  the  nervous  strength  very 
difficult  to  account  for. 

One  degree  further,  and  the  expiration,  more  violent 
and  accompanied  with  spasms  of  the  glottis,  will  bring 
about  the  most  varied  cries,  the  famous  hysterical  barks. 
You  know  that  they  occurred  epidemically  in  the  Middle 
Ages,  and  that,  in  the  convents,  nuns  began  by  hundreds 
to  howl,  bark,  or  mew.  It  was  necessary  to  threaten 
them  with  a  hot  iron  to  silence  them.  It  is  by  far  less 
widespread  nowadays  and  is  not  so  epidemic,  but  never- 
theless it  exists  very  often  under  various  forms.  In 
many  cases,  this  tic  is  mixed  with  some  phenomena  of 
disturbances  of  speech  of  which  we  have  already  spoken. 
Little  by  little,  the  bark  becomes  a  particular  word,  the 
name  of  a  person,  or  some  obscenity  or  other. 

You  understand,  in  fact,  that  all  these  various  tics 
we  have  analyzed  may  be  mixed  with  one  another  and 
give  rise  to  complex  phenomena.  One  of  the  most 
interesting  is  that  to  which  I  alluded  just  now  when 
speaking  of  the  hiccough.  The  hiccough,  through  the 
vacuum  it  determines  in  the  thorax,  produces  a  draught 
in  the  oesophagus  and  causes  the  subjects  to  swallow  air. 
After  three  or  four  hiccoughs,  the  stomach  is  full  of  air, 
which  brings  about  another  fact ;  namely,  the  expulsion 
of  those  gases  from  the  stomach  through  an  eructation. 
Therefore,  as  you  may  easily  notice,  great  hiccoughs  are 
always  interrupted  now  and  then  by  eructations  of 
different  tones.  I  used  to  note  down  in  the  following 
manner  the  noises  that  one  of  my  patients  regularly 
made :  "nioup,  nioup,  nioup,  zaa,"  and  thus  indefinitely. 
This  same  patient  complicated  her  respiratory  dis- 


Tics  of  Respiration  and  Alimentation     263 

turbances  a  little  by  adding  to  them  disturbances  of 
speech.  Thus,  the  noises  of  her  hiccough  were  often 
transformed  into  veritable  words ;  now  and  then,  she 
would  repeat:  "all  right,"  and  "all  rock,"  which 
sounded  about  like  the  name  of  her  medical  attendant. 
It  even  appears  that  the  noise  "  nioup,  nioup  "  had  been 
consequent  on  the  reading  of  a  novel  in  which  some 
savages  sang :  "  iou,  iou." 

With  those  same  complex  tics  of  respiration  I  should 
like  to  connect  an  exceedingly  curious  phenomenon; 
the  swelling  of  the  abdomen  or  meteorism.  It  is  neces- 
sary that  you  should  know  this  phenomenon  well,  be- 
cause it  is  the  one  which  gives  rise  to  the  most  common 
and  grotesque  medical  errors.  You  know  of  those 
newly  married  young  women  who  long  to  have  a  child ; 
the  menses  are  suppressed,  the  abdomen  becomes  big 
and  hard,  the  breasts  hard  and  coloured;  there  are 
nauseas  and  vomitings.  A  midwife  is  called  in.  She 
feels  the  arm  of  the  child  and  fixes  the  date  of  the 
delivery.  This  date  comes  and  nothing  ceases;  the 
expectation  continues.  One  fine  day,  everything  dis- 
appears, without  its  being  possible  to  know  what  has 
become  of  the  child.  It  is  the  famous  nervous  preg- 
nancy, of  which  I  have  noted  down  about  ten  cases,  and 
of  which  one  should  beware.  The  error  is  less  serious 
here  than  when  these  swellings  of  the  body  are  attributed 
to  various  tumours,  and  operations  are  counselled. 

However  that  may  be,  this  abdominal  swelling  is  not 
very  easy  to  account  for ;  the  old  theories  of  the  time  of 
Charcot  connected  it  with  a  paralysis  of  the  intestinal 
walls,  admitting  of  the  dilatation  of  the  gases.  I  am 


264      The  Major  Symptoms  of  Hysteria 

much  more  inclined  at  the  present  day  to  believe  that 
it  is  due  to  respiratory  phenomena.  One  of  those 
phenomena  is  a  spasm  of  the  diaphragm,  which  re- 
mains lowered  and  compresses  the  viscera  forward ;  but 
it  only  brings  about  the  smaller  swellings.  The  other 
is  in  relation  with  that  same  aerophagia  which  I  have 
just  mentioned.  Certain  patients  eject  the  air  they 
have  inhaled  by  means  of  eructations.  Others  do  not 
succeed  in  emptying  their  stomach  through  the  upper 
end;  they  force  their  pylorus  open  and  send  this  air 
into  their  intestine,  which  determines  varied  disturbances 
of  the  digestion,  and,  in  particular,  diarrhoea,  but,  at 
the  same  time,  a  sometimes  enormous  swelling  of  the 
whole  abdomen.  You  may  imagine  many  other  com- 
binations of  these  respiratory  disturbances. 

Ill 

But,  before  leaving  the  subject  of  visceral  disturb- 
ances, I  should  like  to  tell  you  briefly  of  some  other  very 
important  tics  which  depend  on  the  function  of  alimen- 
tation, of  which  we  have  spoken.  Most  of  these  tics  of 
alimentation  besides  are  at  the  same  time  complicated 
with  a  respiratory  phenomenon. 

In  the  first  place,  the  function  of  alimentation, 
emancipated  from  the  personal  consciousness,  may  be- 
come exaggerated  and  give  rise  to  various  forms  of 
bidimia.  Patients  affected  with  bulimia  cannot  stop 
eating;  they  constantly  ask  for  food.  The  fact  of 
bulimia,  it  is  true,  exists  in  hysteria,  but  be  on  your 
guard ;  it  mostly  belongs  to  psychasthenic  impulsions. 


Tics  of  Respiration  and  Alimentation     265 

It  is  to  be  met  with  among  those  patients  who  feel 
weakened,  depressed,  and  have  taken  the  mania  to 
revive  themselves  by  some  stimulant  or  other,  adopted 
more  or  less  at  haphazard.1 

Some  have  the  mania  of  always  eating;  others  — 
and  they  are  the  most  numerous  —  have  the  mania  of 
drinking  alcohol.  Yet  there  is  one  form  of  those  manias 
which  is  in  relation  with  a  hysterical  phenomenon,  and 
which  it  is  right  that  you  should  know.  It  is  polydipsia, 
which  is  not  to  be  confounded  with  dipsomania.  The 
dipsomaniac  seeks  after  exciting  drinks  and  it  is  alcohol 
he  wants  to  swallow.  The  polydipsical  is  not  so  hard 
to  please ;  he  is  content  with  pure  water,  but  he  swallows 
twenty  liters  of  it  a  day.  This  excess  of  drink  has  an 
inevitable  consequence;  namely,  an  excess  of  urine, 
polyuria.  Some  of  these  patients  discharge  eighteen  liters 
a  day.  Curiously  enough,  more  stress  has  generally 
been  laid  on  this  consequence  of  the  phenomenon  than 
on  the  phenomenon  itself.  Polyuria  was  studied  among 
the  disturbances  of  the  renal  secretion  to  be  met  with 
in  neuropathic  patients.  I  think  it  should  rather  be 
connected  with  deliriums  or  with  the  disturbances  of  the 
functions  of  alimentation,  which  bring  about  the  im- 
pulsion to  drink  indefinitely. 

But  after  those  great  automatisms  of  the  function  of 
alimentation,  we  have  to  point  out  a  host  of  partial  dis- 
turbances, spasms  of  the  jaws  and  cheeks,  spasms  oj 
the  pharynx,  tics  of  perpetual  spitting  and  salivation. 

1  Pierre  Janet,  "  On  the  Pathogenesis  of  Some  Impulsions," 
The  Journal  of  Abnormal  Psychology,  edited  by  Morton  Prince, 
April,  1906,  p.  3. 


266      The  Major  Symptoms  of  Hysteria 

Ptyalism,  which  is  frequent  in  certain  melancholy 
deliriums,  exists  also  in  hysteria.  I  do  not  insist  on  the 
spasms  of  the  oesophagus,  to  which  we  alluded  in  our 
last  lecture.  You  also  know  the  tics  of  eructation  and 
the  belches,  of  which;  I  have  just  spoken  to  you  in  con- 
nection with  the  hiccbugh.  But  I  must  point  out  to  you 
a  complication  of  the  phenomenon,  which  is  called 
regurgitation,  merycism.  Some  of  these  patients  learn 
to  ruminate  like  cows.  They  know  how  to  bring  back 
into  their  mouths  the  food  they  have  swallowed.  It  has 
been  said  that  this  constituted  an  odd  physiological 
phenomenon,  in  which  the  movement  of  the  oesophagus 
was  reversed.  I  think,  rather,  that  it  is  one  of  those 
curious  phenomena  of  aspiration,  induced  by  abnormal 
respirations.  By  making  a  movement  of  aspiration 
very  quickly  while  shutting  the  glottis  and  preventing 
the  air  from  entering  into  the  lungs,  one  induces  a 
vacuum  in  the  thorax,  which  can  react  on  all  sides.  A 
certain  individual,  who  was  formerly  celebrated  in  Paris, 
thus  drew  up  air  through  his  anus  and  knew  how  to 
eject  it  in  a  melodious  way.  We  know  that  many  thus 
draw  air  into  their  oesophagus.  But  the  aspiration  into 
the  oesophagus  may  be  effected  in  the  opposite  direction 
and  throw  up  the  contents  of  the  stomach.  We  shall 
see  this  mechanism  assume  a  greater  importance  still 
in,  the  following  phenomenon,  the  only  one  that  is  really 
important ;  namely,  hysterical  vomiting. 

Hysterical  vomiting  is  almost  as  serious  as  anorexy 
itself.  It  is  certainly  responsible  for  several  deaths.  It 
almost  always  complicates  all  the  preceding  disturb- 
ances. This  vomiting  is  rarely  pure ;  that  is  to  say,  it 


Tics  of  Respiration  and  Alimentation     267 

rarely  depends  on  hysteria  alone.  Nowadays,  as  I 
told  you  at  the  outset,  the  attention  of  physicians  is 
much  more  directed  to  associated  hysteria,  to  the 
organic  affections  that  are  at  the  starting-point  of 
hysteria,  or  its  localizations.  Lately,  MM.  Mathieu 
and  Roux,  in  a  paper  in  the  Gazette  des  Hdpitaux,1  again 
insisted  on  this  point  in  connection  with  hysterical  vomit- 
ings. Almost  always,  they  said,  there  is  at  the  starting- 
point  some  organic  affection  which  induces  the  beginning 
of  the  phenomenon.  This  primum  mobile  may  be  either 
the  vomitings  in  pregnancy,  or  alcoholic  gastrites,  or 
gastrites  of  any  kind,  or,  above  all,  ulcers  of  the  stomach, 
of  which  we  shall  have  to  speak  again. 

But,  however  it  may  be,  what  characterizes  the  phe- 
nomenon is  the  exaggeration  and  regular  and  indefinite 
reproduction  of  the  vomiting  long  after  the  action  of 
its  cause.  This  vomiting,  in  fact,  is  exceedingly  rapid 
and  easy;  it  immediately  follows  the  meal;  it  is  ac- 
companied with  very  little  nausea  and  no  effort.  It  is 
repeated  with  any  kind  of  food  and  produces  the  most 
dangerous  inanition.  It  is  also  in  cases  of  this  kind, 
that  the  tuberculous  complications  supervene  which 
almost  always  terminate  hysterical  inanitions.  A 
rather  characteristic  phenomenon  is  that  the  patients 
cannot  seem  to  endure  the  arrest  of  the  vomiting. 
When,  through  any  process,  they  are  prevented  from 
vomiting,  they  exhibit  anguish,  are  agitated,  writhe  in 
every  way,  complain  of  a  thousand  sufferings,  and 
finally  become  unconscious  in  a  great  hysterical  attack. 

1A  Mathieu  and  J.  Ch.  Roux,  "L'Hyste'rie  Gastrique,"  Gazette 
des  Hdpitaux,  February  22,  1906. 


268      The  Major  Symptoms  of  Hysteria 

Many  patients  have  thus  to  choose  between  delirious 
attacks  and  perpetual  vomiting.  This  is  quite  the 
character  of  an  automatic  agitation  which  they  can  no 
longer  control. 

Formerly  an  apparently  very  serious  accident  was 
always  brought  close  to  hysterical  vomiting,  namely,  the 
vomiting  of  blood,  and  these  hematemeses  were  un- 
hesitatingly connected  with  hysteria.  It  had  been 
noticed,  and  that  very  rightly  too,  that  these  hema- 
temeses almost  always  coincided  witfc  the  beginning  of 
the  menses,  and  it  was  usually  said  that  these  women 
have  their  menses  through  their  stomachs.  At  the  pres- 
ent time,  this  notion  of  these  neuropathic  gastric  hemor- 
rhages tends  to  become  obliterated,  and  physicians  are 
inclined  to  say  that  they  are  due  to  an  unrecognized 
ulcer  of  the  stomach.  The  symptoms  that  were  formerly 
indicated  as  conducing  to  the  diagnosis  seem  to  have 
lost  something  of  their  value.  The  pain  occurring  long 
after  the  meal,  the  irregular  paroxystic  crises,  the  rela- 
tion with  the  menses,  even  the  relation  with  moral 
emotions,  all  that  was  found  again  in  the  ulcer.  Kuttner 
in  1895  pointed  out  a  patient  whose  first  vomiting  of 
blood  came  on  after  the  death  of  a  relative.  He  was 
led  to  cut  open  her  stomach  and  found  a  real  ulcer. 
Another  woman,  after  a  scene  in  which  her  daughter 
left  home  forever,  had  a  vomiting  of  blood  which  formerly 
would  have  been  unhesitatingly  connected  with  emotional 
neuropathic  disturbances.  Her  stomach  was  also  cut 
open,  and  an  ulcer  was  found.  It  is  in  the  work  of 
MM.  Mathieu  and  Roux  that  you  will  find  a  very  well- 
conducted  discussion  of  this  fact.  The  authors,  how- 


Tics  of  Respiration  and  Alimentation     269 

ever,  hesitate  to  make  a  complete  denial  of  purely 
hysterical  hematemeses.  They  admit  it  in  hemor- 
rhagic  pituites,  in  pituitous  vomitings  tinted  with  blood, 
in  hematemeses  coinciding  with  multiple  hemorrhages 
of  the  skin,  of  the  ear.  Then  why  should  it  not  be 
admitted  that,  in  certain  cases,  this  disposition  to  hemor- 
rhage may  be  localized  in  the  stomach? 

Be  very  prudent,  however,  in  this  diagnosis,  which, 
at  the  present  time,  must  be  less  readily  accepted  than 
formerly.  The  same  prudence,  even  still  greater  pru- 
dence, is,  of  course,  necessary  when  you  have  to  deal 
with  fecaloid  or  still  stranger  vomitings  which  some  of 
those  subjects  may  exhibit.  They  are  almost  always 
due  to  simulations  or  deliriums,  which  you  must  know 
how  to  recognize.  The  real  tics  of  alimentation  and 
respiration  we  have  just  described  are  numerous  enough 
for  us  not  to  complicate  their  list  with  doubtful  phe- 
nomena. One  of  the  characteristics  of  the  present  study 
of  hysteria  is  that  efforts  are  made  to  limit  the  disease 
more  clearly  than  formerly  and  to  leave  out  mysterious 
phenomena  or  phenomena  depending  on  another  malady. 
Our  enumeration  of  the  symptoms  of  hysteria  is  already 
complete  enough,  and  we  can  now  enter  upon  more 
general  studies  on  the  common  characteristics  of  these 
diseases. 


LECTURE  XIII 
HYSTERICAL  STIGMATA  —  SUGGESTIBILITY 

The  need  of  unity  in  presence  oj  the  diversity  0}  hysterical 
phenomena  —  The  problem  of  the  stigmata —  The  stigma  of 
anesthesia  —  The  historical  importance  of  this  stigma  — Its 
exaggeration  —  The  two  meanings  of  the  word  "  stigma  "  — 
The  psychological  stigmata  —  The  character  of  hystericals 
—  Instinctive  falsehood  —  The  mental  stigma  of  suggesti- 
bility—  The  distinct  meaning  of  the  word  "  suggestion  "  — 
Description  of  the  principal  facts  of  suggestion  —  The 
complete  development  of  the  elements  contained  in  an  idea, 
without  any  participation  of  the  will  or  of  the  personal  con- 
sciousness—  The  distinction  between  real  suggestion  and 
normal  phenomena  —  The  conditions  of  suggestion  —  The 
systematization  of  images  —  The  absence  of  suggestion 
properly  so-called  with  normal  people  —  The  weakening 
of  consciousness,  the  lack  of  synthesis  —  Suggestibility  as 
a  sign  of  hysteria  —  The  disappearance  of  suggestibility 
after  recovery  from  hysteria 

THE  examination,  even  rapid,  of  the  numerous  acci- 
dents of  hysteria  raises  inevitable  problems  in  our  minds. 
The  most  important  one,  the  one  that  always  torments 
the  human  mind  in  all  possible  studies,  is  the  problem 
of  unity,  of  the  conception  of  the  whole,  of  the  essential 
and  fundamental  character.  The  first  authors  who 
described  hystericals  were  always  struck  with  the 
diversity  and  complexity  of  their  symptoms.  "It  is 

270 


Hysterical   Stigmata — Suggestibility      271 

not  a  disease,"  said  one  of  them,  "it  is  a  host  of  ail- 
ments." And  you  know  that,  to  express  the  change- 
ableness  of  hysteria,  Sydenham  called  it  "that  Proteus 
that  cannot  be  laid  hold  of."  Sometimes  it  takes  the 
form  of  deliriums  such  as  we  have  seen  in  somnam- 
bulisms, and  we  are  in  the  domain  of  mental  diseases. 
Sometimes  it  presents  accidents  of  the  arms  and  legs, 
which  make  us  think  of  articular  and  muscular  lesions. 
Now  we  meet  with  disturbances  of  the  stomach  or  lungs, 
and  we  have  to  deal  with  visceral  diseases,  gastrites,  and 
pneumonias.  You  may  understand  the  perplexity  of 
the  first  clinicians,  the  best  of  whom  came  to  abhor 
and  loathe  such  a  malady.  They  did  not  seek  to  take 
away  from  it  its  bad  renown,  for  their  scientific  dis- 
satisfaction discomposed  them,  made  them  impatient 
with  the  subject,  and  inclined  them  to  call  him  a  simu- 
lator and  a  debauchee.  Slow  was  the  reaction  against 
this  tendency,  brought  about  by  a  very  natural  per- 
plexity. The  best  answer  has  been  to  make  hysteria 
intelligible,  and,  above  all,  to  seek  to  give  it  some  unity, 
by  linking  together  those  scattered  accidents,  by  find- 
ing in  all  of  them  some  fundamental  features,  which 
serve  at  once  to  explain  them,  to  connect  them  with 
one  another,  to  diagnosticate  and  to  identify  them. 

This  need  of  unity  under  diversity,  which  has  never 
been  so  serious  as  in  the  study  of  hysteria,  has  enlarged 
with  regard  to  this  study  a  problem  that,  upon  the 
whole,  exists  in  every  medical  research :  the  problem  of 
the  stigmata.  If  one  admits  that  somnambulism, 
paralysis,  vomiting  are,  all  three  of  them,  hysterical 
phenomena,  in  spite  of  their  enormous  differences,  there 


272      The  Major  Symptoms  of  Hysteria 

must  be  something  common  among  them.  In  the 
three  patients  a  common  character  must  be  found, 
which  is  with  all  of  them  the  starting-point  of  the  ob- 
served symptom  and  serves  to  diagnosticate  the  hysterical 
character  of  this  accident.  That  common  character  is 
the  stigma,  and  one  may  say  that,  since  the  beginning 
of  the  scientific  study  of  hysteria,  all  the  attention  of 
clinicians  of  any  merit  has  been  directed  to  the  study 
and  search  of  the  stigma. 


Of  course  this  stigma  has  varied  very  much,  for  it 
reflects  the  theories  of  each  period  on  the  diseases  one 
considers.  Now  this  essential  stigma  of  hysteria  was 
the  convulsive  attack,  now  the  hysterical  bawl.  You 
will  read  with  astonishment  the  books  of  the  beginning 
of  the  nineteenth  century,  in  which  you  will  find  that 
hysteria  is  recognized  from  the  bawl  of  nervous  women. 
For  about  fifty  years  past,  other  more  important  char- 
acters have,  become  predominant,  and  you  are  aware 
that,  especially  under  the  influence  of  the  school  of 
Charcot,  one  symptom  has  become  the  preeminent 
stigma;  namely,  anesthesia. 

The  singling  out  of  this  symptom  was,  in  some  degree, 
an  unconscious  return  to  the  past.  In  the  Middle  Ages, 
people  had  also  a  kind  of  diagnosis  to  make,  in  order  to 
recognize  witches  and  those  possessed  as  well  as  possi- 
ble before  burning  them,  and  you  know  the  singular 
method  they  made  use  of.  A  surgeon  or  an  expert 
woman  examined  the  body  of  the  sufferer  on  all  sides, 


Hysterical  Stigmata  —  Suggestibility      273 

testing  the  sensibility  with  a  sharp  needle  in  order  to 
discover  the  devil's  claw,  that  insensitive  patch  which 
was  a  certain  sign  of  witchcraft.  They  examined  every 
nook  and  corner,  for  the  devil  is  in  the  habit  of  con- 
cealing himself  in  the  most  hidden  places,  and  they 
actually  tested  the  sensibility  of  the  mucous  membranes 
as  well  as  that  of  the  skin.  The  fact  is  really  very 
curious  and  shows  an  instinctive  medical  perspicacity 
that  has  not  been  sufficiently  celebrated.  Well,  Charcot 
nearly  brought  us  back  to  the  time  of  the  celebrated 
inquisitor  Bodin,  and,  in  our  clinics,  we  are  somewhat 
like  the  woman  who  sought  for  witches.  We  blindfold 
the  subject,  we  turn  his  head  away,  rub  his  skin  with 
our  nail,  prick  it  suddenly  with  a  hidden  pin,  watch 
his  answers  or  starts  of  pain;  the  picture  has  not 
changed. 

This  research  has  allowed  clinicians  to  establish  that, 
in  many  cases,  various  anesthesias  accompany  most 
hysterical  symptoms.  In  the  case  of  paralyses  or  con- 
tractures  of  the  limbs,  the  phenomenon  is  very  clear 
and  regular,  whether  in  regard  to  cutaneous  sensitive- 
ness, or,  better  still, — for  it  is  very  important, — to 
muscular  sensitiveness.  In  the  case  of  sensorial  acci- 
dents, the  anesthesia  is  very  often  quite  distinct  at  the 
periphery;  sometimes  it  conceals  itself  by  taking 
extremely  interesting  forms,  which  the  inquisitors  did 
not  know  how  to  seek  for,  such  as  the  contraction  of  the 
visual  field.  In  the  case  of  visceral  accidents  and  of 
certain  motor  disturbances  which  are  rather  agitations 
than  paralyses,  the  question  becomes  more  delicate. 
Often  the  superficial  anesthesia  of  the  region  indicates 


274      The  Major  Symptoms  of  Hysteria 

the  diseased  organ,  but,  to  be  sincere,  this  is  not  always 
true.  When  we  have  to  deal  with  the  great  mental 
accidents,  with  all  the  innumerable  forms  of  somnam- 
bulism, the  anesthesia  sought  for  by  Charcot  is  often 
to  be  met  with,  but  it  does  not  constitute  the  absolute 
rule. 

That  method  which  consisted  in  characterizing 
hysteria  by  anesthesia  and  by  the  contraction  of  the 
visual  field  has  enabled  medicine  to  make  great  progress. 
It  has  successively  brought  about  the  discovery  of  a 
crowd  of  unknown  hysterical  symptoms,  of  special 
spasms,  tremors,  localized  pains,  etc.  Must  it  con- 
tinue to  dominate  in  medicine  and  must  anesthesia  be 
made  an  essential  symptom?  The  discussion  on  this 
point  began  at  the  very  outset  of  the  teaching  of  Charcot ; 
his  adversaries  —  and  they  were  numerous  —  always 
opposed  his  interpretation  of  this  symptom.  The  great 
and  interminable  quarrel  about  traumatic  neuroses, 
which  began  especially  in  Germany  in  connection  with 
railway  accidents,  rests  on  this  question.  This  criticism 
is  in  great  part  justified,  for  hysterical  Anesthesia  cer- 
tainly does  not  play  in  practice  the  absolutely  pre- 
ponderant r61e  that  Charcot  maintained  it  did. 

First  of  all,  it  is  only  too  certain  that  this  anesthesia 
is  not  so  easy  to  recognize  as  was  believed.  It  has,  as 
we  have  seen,  very  delicate  psychological  characteristics, 
which  make  the  answers  of  the  subject  very  often  diffi- 
cult to  interpret.  But,  above  all,  it  is  very  mobile,  very 
impressionable.  Now,  your  examination  alone  will 
suffice  to  cause  a  real  anesthesia  to  disappear ;  now  — 
and  this  is  more  serious  —  your  manner  of  interrogating 


Hysterical  Stigmata  —  Suggestibility     275 

will  create  outright  an  anesthesia  that  did  not  exist. 
The  study  of  the  stigmata  is  made  on  no  patients  so 
well  as  on  old  ones,  real  pillars  of  the  hospital,  who 
have  already  been  examined  thousands  of  times.  When 
you  have  to  deal  with  new  patients,  who  have  not  yet 
been  touched,  you  recognize  with  astonishment  that 
anesthesia  is  rarer,  less  important  than  Charcot  said. 
On  this  point  I  apologize  myself,  and  acknowledge 
that,  under  the  influence  of  la  Salpetriere,  I  formerly 
attributed  more  importance  to  anesthesia  than  I  would 
do  now. 

What  then  must  be  our  conclusion  as  to  the  r61e  of 
anesthesia  as  a  stigma?  We  should  understand  one 
another  and  not  ask  the  sciences  of  observation,  which 
are  so  difficult,  to  furnish  us  with  absolute  theorems. 
In  my  opinion,  the  two  meanings  of  the  word  "stigma" 
should  be  separated.  In  the  first  place,  it  has  a  theo- 
retical meaning,  it  indicates  the  fundamental  character, 
the  causal  character  from  which  the  rest  of  the  disease 
springs.  For  instance,  if  you  consider  a  tuberculous 
lesion,  the  real  stigma  will  be  the  bacillus  of  Koch,  be- 
cause we  consider  it,  at  least  at  the  present  day,  as  the 
cause  of  all  the  innumerable  lesions,  however  varied 
they  are.  It  will  be  the  same  with  the  existence  of 
the  pale  spirochsete  of  Schaudin  in  syphilis,  if  the  hypoth- 
esis is  corroborated.  Now,  we  must  own  that  anes- 
thesia does  not  play  this  r61e  in  hysteria,  that  we  do 
not  know  the  microbe  of  that  malady,  that  there  is 
probably  none,  and  that  we  know  no  better  its  his- 
tological  lesion.  From  this  standpoint,  Charcot's  stigma 
has  failed. 


276      The  Major  Symptoms  of  Hysteria 

But  the  stigma  has  another  meaning,  which  is  prac- 
tical. It  is  a  mere  means  of  diagnosis.  Now,  anesthesia 
accompanies  two-thirds  of  the  hysterical  accidents.  It 
has,  besides,  the  -character  of  persisting  long  after  the 
disappearance  of  the  accident.  The  result  is  that 
almost  all  the  hystericals  who,  at  present,  show  a  serious 
phenomenon,  have  had  in  the  past  one  of  those  acci- 
dents that  leave  behind  them,  as  a  trace,  some  persisting 
anesthesia.  I  examine  in  a  subject  a  perplexing  mental 
or  sensorial  disturbance,  and  find  traces  of  a  hemi- 
anesthesia.  It  means  that,  in  the  course  of  his  life,  he 
has  already  had,  in  a  greater  or  smaller  degree,  a  hysterical 
hemiplegy.  I  establish  with  him  a  contraction  of  the 
visual  field  which  he  did  not  even  know;  it  proves  to 
me  that  he  has  had  in  a  greater  or  smaller  degree  a 
hysterical  amaurosis.  Is  not  this  recognition  extremely 
important  for  the  interpretation  of  the  present  accident, 
even  if  I  do  not  believe  at  all  that  this  anesthesia  ac- 
counts for  his  accident?  Very  often,  in  medicine,  the 
stigmata  are  not  so  serious  as  the  bacillus  of  Koch. 
You  examine  a  patient  who  has  serious  intestinal  dis- 
turbances and  fever;  you  seek  on  his  breast  for  the 
little  rosy  lenticular  spots,  and,  if  you  find  them,  you 
say :  "  It  is  typhoid  fever."  Yet  you  do  not  know  the 
r61e  of  those  spots  in  the  evolution  of  typhoid  fever. 

I  think,  therefore,  that  the  anesthesia  of  Charcot  must 
remain  in  practice  a  very  important  stigma,  the  search 
for  which  is  in  the  first  rank  of  the  methods  of  diagnosis, 
but  that  it  is  not  the  only  or  fundamental  symptom  of 
hysteria.  There  are  some  troubles  and  symptoms 
which  we  connect  with  hysteria,  though  we  do  not 


Hysterical  Stigmata  —  Suggestibility     277 

recognize  any  anesthesia.     We  must  look  more  deeply 
for  other  phenomena  playing  the  r61e  of  stigmata. 

n 

Anesthesia  pleased  the  physicians,  because  this  symp- 
tom is  in  some  manner  intermediate  between  physical 
and  moral  phenomena.  They  could  not  make  up  their 
minds  to  make  hysteria  a  purely  mental  malady.  They 
always  declared  that  such  was  the  case,  but,  in  reality, 
they  quickly  forgot  that  declaration  to  consider  by  pref- 
erence physical  symptoms  and  measure  them  through 
physical  methods.  Since  hysteria  has  become  a  more 
distinctly  mental  malady,  it  is  in  the  mind  that  we 
must  seek  for  the  stigmata  and  that  we  have  a  chance 
to  find  more  general  stigmata  co-existing  with  all  the 
accidents. 

Scientists  had  long  felt  that  there  was  a  hysterical 
mental  state ;  you  know  that  it  was  the  fashion  to  write 
theses  on  the  character  of  hystericals.  There  were 
first  brought  into  relief  in  the  works  of  Legrand  du 
Saulle,  Ballet,  Mcebius,  Tardieu,  Richet,  etc.,  certain 
curious  and  striking,  but  of  course  somewhat  excep- 
tional, features.  Our  poor  patients  were  not  lucky. 
Formerly,  they  were  burnt  as  witches ;  then,  they  were 
accused  of  all  possible  debaucheries;  then,  when  the 
manners  had  become  gentler,  one  was  content  with 
saying  that  they  were  versatile  to  excess,  remarkable 
for  their  spirit  of  duplicity,  of  falsehood,  of  perpetual 
simulation.  "A  common  feature  characterizes  them," 
says  Tardieu;  "namely,  instinctive  simulation,  the  in- 


278      The  Major  Symptoms  of  Hysteria 

veterate  and  incessant  need  of  unceasingly  lying,  with- 
out reason,  solely  for  the  sake  of  lying,  and  this  not 
only  in  words,  but  also  in  action,  by  a  kind  of  parade 
in  which  the  imagination  plays  the  principal  part,  gives 
birth  to  the  most  inconceivable  incidents  and  sometimes 
proceeds  to  the  most  disastrous  extremities."  So  false- 
hood becomes  the  stigma  of  hysteria. 

Do  not  smile;  there  are  still  many  physicians  who 
take  that  seriously.  No  doubt  falsehood  exists  in 
hysteria ;  and  often  it  is  even  very  amusing.  I  regretted 
very  much,  when  we  studied  mental  disturbances,  not 
having  the  time  to  devote  a  lecture  to  the  accidents  of 
falsehood.  I  have  known  two  or  three  subjects,  one 
especially,  who  were  really  magnificent.  This  poor 
woman  has  had  all  her  life  —  that  is,  for  thirty  years  — 
an  extravagant  need  of  falsehood,  above  all,  of  false- 
hood by  letters.  Her  greatest  happiness  consists  in 
devising  amorous  correspondence ;  she  sends  to  an  in- 
dividual, man  or  woman,  marvellous  letters  in  which 
she  states  that  he  or  she  has  inspired  her  with  a  sudden 
love  when  passing  on  the  promenade.  What  is  most 
wonderful  is  that  it  always  takes.  The  gentleman 
answers  paste  restante,  and  she  goes  on  with  the  cor- 
respondence for  months  or  years.  What  is  sad  is  that 
it  ended  before  the  assizes ;  but  the  observation  deserves 
to  be  published. 

Falsehood  is,  in  my  opinion,  one  of  the  mental  acci- 
dents of  the  neurosis,  one  of  the  deliriums  that  the 
hysterical  may  have  in  a  very  serious  or  in  an  attenuated 
degree,  just  as  she  may  have  somnambulisms  or  fugues ; 
that  is  to  say,  ambulatory  fits.  But  it  is  very  well  known 


Hysterical  Stigmata  —  Suggestibility      279 

that  all  hystericals  have  not  necessarily  made  fugues. 
Likewise  they  have  not  necessarily  all  of  them  the  mental 
accident  of  falsehood.  Its  frequency  has  been  much 
exaggerated.  It  has  been  so  often  described  that,  in 
the  end,  patients  were  trained  to  present  it.  Formerly, 
Legrand  du  Saulle  was  convinced  that  all  hystericals 
had  red  flowers  in  their  hair  and  red  ribbons  tied  to 
their  bedsteads;  at  length  he  made  them  believe  it. 
We  cannot  dwell  on  these  first  mental  stigmata,  which 
only  show  the  importance  that  must  be  attached  to 
psychological  disturbances. 

In  reality,  the  great  mental  stigma  that  modern  studies 
have  brought  into  evidence  is  the  mental  phenomenon 
of  suggestion.  No  doubt  I  begin  to  think  that  the  im- 
portance given  to  it,  in  particular  in  the  last  works  of 
Babinski,  is  somewhat  exaggerated,  but  it  is  certain 
that  this  exaggeration  is  as  yet  very  slight,  and  that 
suggestion  is  indeed  one  of  the  most  fundamental  stig- 
mata of  the  hysterical  state.  But  it  is  necessary  to 
define  this  phenomenon  exactly,  to  give  a  distinct 
meaning  to  the  word,  because  physicians  are  in  the 
habit  of  using  it  in  an  extremely  vague  manner,  of 
comprising  under  this  word  all  possible  mental  phe- 
nomena. 

It  is  needless  to  recall  the  fundamental  phenomena 
of  suggestion;  you  know  them  very  well.  You  cause 
any  idea  whatever  to  penetrate  into  the  mind  of  the 
subject  through  any  means  you  please,  through  sensa- 
tions, signs,  and  especially  speech.  Note  this  fact: 
there  must  be  an  idea.  The  subject  must  have  the 
thought,  the  conception  of  something  precise.  This 


280      The  Major  Symptoms  of  Hysteria 

idea  does  not  seem  to  conduct  itself  in  him  as  it  usually 
does  in  normal  minds. 

When  somebody  puts  an  idea  into  our  head,  this 
idea  brings  in  its  train,  it  is  true,  other  thoughts  which 
revolve  around  it,  some  more  or  less  vague  images, 
some  gestures,  or  some  incipient  movement.  If  you 
speak  to  me  of  the  falls  of  the  Niagara,  I  cannot  help 
seeing  dimly,  in  a  kind  of  penumbra,  a  few  fragments 
of  that  fine  scenery.  If  I  am  surrounded  with  calm,  I 
shall  be  able  to  dwell  a  little  on  that  remembrance  and 
to  call  to  mind  a  few  particulars  of  my  journey.  The 
images  I  see  are  always  dim,  and  the  words  I  speak,  I 
speak  to  myself.  I  always  know  very  well  that  I  am 
not  actually  before  the  falls,  and  in  reality,  I  do  not  see 
them.  If  you  speak  to  me  of  dancing,  of  balls,  of 
rhythmical  music,  the  idea  awakens  in  me,  even  to  this 
day,  an  inclination  to  move  my  legs,  feelings  of  rhythms. 
I  may  even  go  so  far  as  to  move  my  feet  in  cadence. 
But  don't  be  afraid,  nobody  in  a  drawing-room  will 
be  aware  of  it,  for  the  movement  is  very  slight  and  is 
perceptible  only  to  myself.  It  is  thus  that  things  happen 
when  ideas  are  called  up  in  our  minds. 

It  is  quite  different  with  really  suggestible  individuals. 
The  idea  seems  to  be  transformed  and  to  become  at 
once  another  psychological  phenomenon,  an  act  or  a 
perception.  In  fact,  they  almost  immediately  move 
their  limbs  in  a  manner  quite  visible  outwardly.  They 
really  get  up  and  dance ;  they  walk,  run,  jump,  struggle, 
cry.  Instead  of  confining  themselves  to  thinking  the 
object,  they  seem  to  see  it  in  reality  or  to  hear  it.  They 
conduct  themselves  before  our  eyes  like  individuals  who 


Hysterical  Stigmata  —  Suggestibility      281 

have  perceptions  and  not  ideas ;  they  reply  to  imaginary 
words;  their  facial  expression  is  that  of  a  person  who 
hears.  If  we  question  them,  they  tell  us  without  hesi- 
tation that  they  see  Niagara  before  them,  and  the 
spectacle  has  so  much  intensity  that  it  seems  completely 
to  efface  the  normal  vision  of  the  things  that  surround 
them. 

Other  ideas  become  connected  with  the  first,  still 
with  the  same  intensity  and  the  same  transformation 
into  actions  and  perceptions.  They  seem  to  make  a 
complete  journey ;  they  go  along  the  edge  of  the  falls, 
over  the  bridge,  down  the  ravines;  they  receive  the 
water  in  their  face,  etc.  All  these  ideas  grouped  to- 
gether form  a  very  close  association  in  their  mind,  and 
it  will  henceforth  suffice  to  call  up  one  to  give  birth  to 
all  the  others.  It  is  no  longer  necessary  to  say  the 
word  "  Niagara."  A  mere  vague  noise  brings  about  the 
whole  dream.  These  associations  are  very  important 
in  suggestions,  for  they  determine  particular  reactions 
of  the  subjects  to  such  or  such  excitation.  Thus  such  a 
subject  may  have  acquired  the  habit  of  convulsions  or 
contractures  of  the  limbs  when  he  sees  an  electric  ap- 
paratus or  is  touched  with  a  magnet.  These  patients 
have  shakes  in  their  muscles  as  soon  as  you  put  the 
electrodes  of  the  apparatus  on  their  arms,  even  if  the 
current  does  not  pass  through.  Others  will  experience 
burns  or  refrigerations  or  will  feel  relieved  when  they 
see  gold,  silver,  or  iron  plates  applied  to  their  limbs.  It 
is  that  which  has  caused  so  many  gross  medical  mis- 
takes. Alas,  what  is  left  of  the  big  books  on  the  action 
of  metallic  plates,  of  resin  plates,  on  the  action  of  a 


282      The  Major  Symptoms  of  Hysteria 

breath,  indicated  by  M.  Dumontpallier,  on  the  action  of 
passes  of  the  bands  turned  pointwise  towards  the  sub- 
ject ? 

Another  important  characteristic  of  suggestion  will 
manifest  itself  in  the  visceral  domain.  No  doubt  cer- 
tain ideas  awaken  also  in  us  certain  visceral  sensations, 
a  slight  nausea,  or  vesical  sensations,  but  all  that  is 
very  slight,  just  like  the  feeling  of  dancing.  An  essential 
trait  of  those  patients,  it  was  said,  is  that  they  make  their 
thoughts  penetrate  into  their  viscera.  The  idea  of 
vomiting  brings  about  real  vomiting,  an  imaginary 
purge  with  pure  water  brings  about  a  real  diarrhoea ; 
the  menses  are  stopped  or  restored  with  pills  of  mica 
panis.  This  is  again  a  very  essential  phenomenon,  for 
it  seems  to  come  close  to  the  real  accidents  which  are  to 
be  observed  with  patients  in  many  circumstances. 

We  may  generalize  the  essential  phenomena  that  take 
place  in  these  different  cases.  The  idea  is  always,  as 
we  have  already  remarked  with  regard  to  somnam- 
bulisms, a  system  of  images,  each  of  which  has  dif- 
ferent muscular  or  visceral  properties  (see  the  figure  i 
in  the  first  lecture).  With  the  normal  man,  these  systems, 
which  are  always  very  numerous,  stop  one  another  and 
do  not  develop.  In  suggestion,  each  idea  seems  to 
develop  to  the  maximum,  to  give  all  it  contains  in  the 
way  of  images,  muscular  movements,  and  visceral  phe- 
nomena. This  complete  development  of  all  the  elements 
contained  in  an  idea  is  an  essential  characteristic  of  the 
phenomenon. 

But,  you  may  say,  this  development  can  also  be  some- 
times effected  with  us.  A  painter,  a  novelist,  develops 


Hysterical  Stigmata  —  Suggestibility      283 

his  ideas,  seeks  for  all  their  elements,  renders  them  as 
living  as  possible.  It  is  what  all  of  us  do  when  we  try 
to  perform  some  work,  for  then  the  idea  brings  about 
material  movements  of  our  limbs.  The  thought  of 
looking  for  a  book  causes  me  really  to  look  for  it.  This 
is  quite  true,  but,  in  all  these  cases,  the  development 
only  takes  place  through  a  particular  mechanism.  An 
accessory  force  is  added  to  the  idea  by  the  will ;  namely, 
attention,  personality.  These  words  represent  an  en- 
semble of  very  powerful  tendencies,  which  are  formed 
in  us  by  all  our  past,  and  these  tendencies  are  added 
to  the  idea,  too  weak  by  itself,  to  make  it  grow.  You 
know  the  trouble,  the  voluntary  and  conscious  effort 
that  the  development  of  his  idea  costs  an  artist. 

In  suggestion  you  meet  with  nothing  of  the  kind. 
There  is  no  effort  on  the  part  of  the  subject,  no  addition 
of  strength  from  his  anterior  tendencies,  no  work  of 
his  personality.  On  the  contrary,  he  does  not  seem  to 
realize  the  development  of  what  takes  place  within  him. 
As  has  often  been  recognized,  he  forgets  his  sugges- 
tions as  soon  as  they  are  ended.  He  seems  to  be  very 
little  conscious  of  them  while  they  are  being  executed. 
Very  often  he  executes  them  without  knowing  it,  quite 
subconsciously.  In  this  connection,  it  is  very  important 
to  remark  that  not  all  the  phenomena  executed  by  sub- 
jects of  this  kind  are  suggestions.  They  may,  like 
normal  individuals,  act  out  of  compliance  with  our  desire, 
add  to  the  idea  the  force  given  them  by  the  wish  to  obey, 
to  ingratiate  themselves  with  us,  by  a  regard  to  their 
interest  or  the  fear  of  punishment.  One  should  not  say 
that  a  hospital  patient,  whom  one  frightens  and  be- 


284      The  Major  Symptoms  of  Hysteria 

wilders,  and  who  hastens  to  execute  any  foolish  act  in 
order  not-  to  displease  the  physician,  is  an  individual 
beset  with  a  suggestion.  In  order  that  there  may  be 
suggestion,  it  is  precisely  necessary  that  all  these  normal 
causes  of  development  should  be  wanting,  and  that  the 
idea  should  seem  to  develop  to  the  extreme,  without  any 
participation  0}  the  will  or  of  the  personal  consciousness 
of  the  subject. 

Bear  this  definition  in  mind;  many  authors,  who 
launched  too  precipitately  into  these  psychological 
studies,  considered  themselves  satisfied  when  they  had 
merely  remarked  the  moral  character  of  the  phe- 
nomenon. They  said  that  suggestion  is  an  idea  that 
penetrates  into  the  mind  of  the  subject,  and  stops 
there.  This  is  childish.  As  I  have  so  often  tried  to 
show,  any  idea  entering  into  the  mind  is  not  a  sugges- 
tion. We  recognize  the  fact  ourselves.  If  we  show 
astonishment  at  the  phenomenon  of  suggestion,  it  is  be- 
cause we  think  it  offers  something  abnormal  and  excep- 
tional. The  subjects  themselves  notice  it.  Their  minds 
are  not  filled  all  day  long  with  suggestions.  They  know 
very  well  how  to  distinguish  what  is  suggestion  in  them 
from  what  is  not.  A  patient  has  sometimes  answered 
me  in  a  vulgar  but  quite  characteristic  way :  "Sir,  I  do 
not  know  the  reason,  but  the  thing  did  not  take." 

"What  do  you  mean?  You  did  not  understand 
what  I  said?" 

"Yes,  I  understood  quite  well." 

"Then  you  do  not  wish  to  do  that,  you  do  not  accept  ?" 

"I  accept  all  you  please.  I  am  quite  ready  to  obey 
you,  and  I  will  do  it  if  you  choose;  only  I  tell  you 


Hysterical  Stigmata  —  Suggestibility      285 

beforehand  that  the  thing  did  not  take."  With  the 
preceding  definition  of  suggestion,  these  answers  of  the 
patient  would  have  no  meaning.  The  idea,  having 
penetrated  into  the  mind  and  having  been  accepted, 
should  be  accounted  a  suggestion.  Yet  the  patient  was 
right ;  she  has  experienced  suggestions,  she  knows  what 
they  are,  and,  although  she  accepted  the  new  idea 
willingly,  and  with  absolute  confidence  and  obedience, 
yet  she  felt  that  things  were  not  proceeding  in  the  same 
way,  and  that  it  was-  not  a  suggestion.  One  should 
not  fall  into  this  exaggeration  and  take  away  from  the 
word  "suggestion"  all  precision  of  meaning.  As  the 
ordinary  psychological  terms,  memory,  association  of 
ideas,  belief,  resolution,  designate  distinct  facts,  so  the 
word  "suggestion"  must  also  designate  a  very  special 
fact,  the  complete  development  of  an  idea  which  takes 
place  without  the  will  and  the  personal  perception  of 
the  subject. 

Ill 

Now  that  you  have  formed  a  precise  idea  of  suggestion 
and  are  not  likely  to  confound  it  with  any  other  psy- 
chological phenomenon,  you  will  readily  accept  an  in- 
evitable consequence  of  this  first  remark;  namely, 
that  suggestion  is  no  longer  a  commonplace  and  constant 
phenomenon.  It  presents  itself  only  in  certain  cases 
and  under  certain  conditions  which  it  is  necessary  to 
determine.  Suggestion  appears  to  us  to  present  two 
great  characteristics:  First,  it  is  a  complete  develop- 
ment ;  second,  it  is  a  development  independent  of  certain 
ideas.  Both  characteristics  require  certain  conditions. 


286      The  Major  Symptoms  of  Hysteria 

It  is  necessary,  in  the  first  place,  in  order  that  an  idea 
shall  develop  itself,  that  the  innumerable  images  of  which 
it  is  composed  be  awakened  and  arrange  themselves  in 
a  series  in  a  proper  manner.  This  is  not  an  unimportant 
condition,  though  it  is  not  always  met.  Certain  minds 
no  longer  retain  images  of  their  sensations  and,  above 
all,  they  no  longer  keep  up  the  systematization  of  these 
images.  They  are  incapable  of  calling  them  up  and 
arranging  them  in  a  series.  They  are  therefore  not 
suggestible  subjects.  The  type  of  such  individuals  will, 
from  the  first,  come  under  the  name  dementia.  It  is 
quite  plain  that  with  an  insane  person  the  images  are 
no  longer  systematized,  and  that,  consequently,  the  ideas 
are  no  longer  either  understood  or  developed.  Much 
hope  has  been  cherished  for  the  therapeutics  of  insanity 
through  suggestion ;  we  are  afraid  this  operation  can  be 
applied  only  to  very  special  cases.  Suggestion  requires, 
in  order  to  be  developed,  a  mind  relatively  sane.  The 
first  condition  of  suggestion  is  a  certain  strength  of  mind, 
and  some  patients  are  not  suggestible  because  they  are, 
so  to  say,  below  suggestion,  like  some  infected  patients 
who  are  incapable  of  having  fever. 

But  ought  we  immediately  to  pass  to  the  other  extreme 
of  opinion  and  maintain  that  suggestion  is  compatible 
with  a  mind  normally  healthy,  and  that  it  is  continually 
met  in  the  sanest  persons?  This  is  an  opinion  which 
appears  to  us  equally  unsound. 

Despite  the  affirmations  of  certain  authors,  we  must 
confess  that  we  have  not  succeeded  in  giving  suggestions 
to  people  of  normal  good  health.  It  is  useless  to  discuss 
the  sense  of  the  word  "health,"  and  to  pretend  that  ideal 


Hysterical  Stigmata  —  Suggestibility     287 

health  does  not  exist.  It  were  repeating  the  sophism 
of  the  Greeks  regarding  the  bald-headed  man.  We 
speak  of  men  generally  considered  normal,  without 
pathological  or  hereditary  antecedents  or  personal 
blemishes  in  a  neuropathic  sense,  without  actual  defects 
medically  appreciable.  If  we  take  a  person  of  that  kind 
(a  kind  that  is  numerous,  we  must  confess),  and  if  we 
state  to  him  that  there  is  a  little  dog  at  the  corner  of  the 
table  where  he  is  sitting,  he  will  laugh  in  our  face  and 
experience  no  hallucination  whatsoever. 

This  fact  appears  to  us  incontestable,  and  to  speak 
of  suggestion  with  sane  persons,  one  is  obliged  to  consider 
quite  different  facts,  effects  of  education,  habits,  rec- 
ollections, beliefs,  etc.  They  are  psychological  phe- 
nomena which  are  apparently  akin  to  suggestion,  but 
the  mechanism  of  which  is  very  different.  These  facts 
have  only  gradually  become  automatic,  thanks  to  the 
patient's  consent.  These  acts,  even  to-day,  are  ac- 
cepted by  the  individual  who  is  aware  of  them  and  as- 
similates them  with  his  personality.  The  result  is  that 
such  actions  are  not  aggressive ;  they  are  limited  in  their 
development  by  other  thoughts  with  which  they  are 
brought  into  relation.  Docile,  obedient  persons,  dis- 
posed to  think  of  others  as  having  more  intelligence  and 
experience  than  themselves,  and,  on  account  of  this, 
apt  to  believe  what  they  are  taught,  are  not  suggestible 
persons.  This  complete  automatic  development  of 
the  personality,  in  the  fashion  of  a  parasite,  is  not  met 
with  in  the  normal  mind. 

On  the  other  hand,  every  time  that  we  have  estab- 
lished in  a  person  unmistakable  suggestibility,  we  have 


288      The  Major  Symptoms  of  Hysteria 

had  no  difficulty  in  demonstrating  numerous  and  evi- 
dent traces  of  mental  disease  more  or  less  grave,  such 
as  excessive  absence  of  mind,  or  even  properly  called 
anesthesias,  attacks,  paralyses,  fixed  ideas.  We  find 
in  the  past  of  such  persons  all  sorts  of  neuropathic 
accidents,  and  the  simple  fact  that  suggestibility  is  still 
persistent  nowadays  should  impose  great  reserve  on  the 
physician  in  regard  to  prognosticating  their  future. 
Suggestibility  with  them  should  in  fact  not  be  considered 
a  simple  exaggeration  of  docility  and  normal  belief. 
Such  persons  are  oftener  neither  docile  nor  believing. 
They  have  an  unsteady,  undisciplined  disposition; 
they  themselves  recognize  that  they  do  not  succeed  in 
believing.  "I  have  no  more  confidence  in  anybody; 
I  have  no  confidence  at  all  in  you,"  they  often  say  to 
me;  and  yet  you  can  make  them  see  through  hallu- 
cinations all  you  wish.  They  are  incapable  of  voluntary 
obedience,  which  demands  strength  of  mind,  and  they 
undergo  in  a  sickly  sort  of  way  all  automatic  impulsion. 
Thus  we  have  admitted  that  suggestion  cannot  develop 
in  sickly  minds,  that  it  demands,  in  order  to  attain  to  its 
full  power,  minds  relatively  sane.  But  we  have  just 
now  demonstrated  that  it  depends  on  a  lack  of  synthesis, 
on  a  weakening  of  consciousness.  Are  not  these  two 
affirmations  contradictory?  A  symptom  may  dis- 
appear in  certain  maladies  and  still  remain  a  patho- 
logical symptom.  The  same  with  suggestion:  it  does 
not  belong  to  all  mental  disorders,  but  it  is  the  sign  of  a 
particular  mental  disease.  It  is  necessary  for  its  oc- 
currence that  the  automatic  association  of  the  psy- 
chological elements  be  preserved,  and  that  the  actual 


Hysterical  Stigmata  —  Suggestibility     289 

synthesis  of  the  phenomena  be  altered  or  reduced. 
It  requires  as  its  essential  condition  a  malady  of  the 
personality. 

It  must  be  confessed  that  there  is  a  particular  disease 
which  unites  in  a  wonderful  manner  the  two  essential 
conditions  of  suggestion,  which  are  the  preservation  of 
automatism  and  the  diminution  of  personal  synthesis; 
this  is  the  hysterical  state.  The  study  of  all  the  accidents 
has  constantly  shown  us  these  two  characteristics  in 
hysteria.  A  tendency  to  suggestion  and  subconscious 
acts  is  the  sign  of  mental  disease,  but  it  is,  above  all,  the 
sign  of  hysteria. 

Let  us  take  another  point  of  view,  and  consider  all 
the  patients  we  clinically  regarded  as  hysterical.     I 
say  that  you  will  almost  always  find  again  in  them,  with- 
out difficulty,  all  the  phenomena  of  suggestion.     First 
of  all  you  will  find  them  experimentally.     If  you  set 
aside   the   old  quarrels  and  examine   calmly  all   the 
subjects  who  have  been  presented  as  fine  examples  of 
suggestion,  you  will  first  see  that  most  of  them  are 
I   somnambulists.     Do  not  forget,  in  fact,  that  it  is  in  the 
\  hypnotic  state  that  suggestion  was  first  described.     Now, 
li  the  hypnotic  state  is  nothing  but  the  reproduction  of  a 
\  hysterical  somnambulism,  and,  I  do  not  hesitate  to  add, 
lj  in  a  hysterical  subject.     Next,  it  has  been  shown  that 
1  suggestion  exists  in  the  waking  state  with  these  same 
subjects,  susceptible  of  presenting  hypnotism.    There 
is  no  need  to  demonstrate  this  diagnosis. 

Then,  suggestibility  has  been  shown  from  time  to  time 
in  individuals  who  were  not  and  had  not  yet  been  hyp- 
notized. Mistrust  these  observations;  you  must  first 


290      The  Major  Symptoms  of  Hysteria 

ascertain  whether  the  suggestions  indicated  were  real 
suggestions,  whether  the  observer,  with  his  preconceived 
ideas,  was  not  content  with  some  naive  obedience  or, 
alas,  with  some  comedy.  But,  if  the  fact  is  true,  and 
it  is  sometimes  so,  examine  the  individual  clinically, 
and  I  assure  you  that  you  will  have  no  difficulty  in 
recognizing  that  he  is  hysterical.  For  my  part,  I  have 
never  seen  a  fine  suggestible  subject  who  was  not 
clearly  hysterical,  and,  inversely,  I  have  been  able  to 
make  all  the  experiments  of  suggestion  on  the  subjects 
who,  on  the  other  hand,  had  decided  morbid  accidents. 
Inversely,  this  relation  between  suggestibility  and 
the  hysterical  neurosis  can  be  verified  in  the  clearest 
manner  by  studying  the  disappearance  of  suggestion. 
In  fact,  as  suggestion  does  not  exist  with  everybody, 
so  you  must  not  fancy  that  it  constantly  exists  during  all 
the  life  of  the  hysterical.  There  are  many  circum- 
stances in  which  the  suggestibility  of  hysteria  tends  to 
disappear.  What  is  most  interesting  in  this  connection 
is  that  it  disappears  completely  when  the  disease  is 
cured.  A  great  number  of  those  persons,  after  having 
kept  for  some  time  both  the  accidents  and  the  mental 
dispositions  that  characterize  this  neurosis,  recover 
completely.  Well,  at  that  moment,  suggestions  no 
longer  take,  and  these  subjects  bear  themselves  in 
regard  to  suggestions  like  normal  individuals.  This 
is  a  very  important  fact,  which  I  have  already  pointed 
out  in  connection  with  hypnotism.  I  have  described  it 
these  twenty  years,  and  the  theoreticians,  who  will 
absolutely  find  hypnotism  and  suggestion  in  everybody, 
have  never  replied  a  word  to  this  argument. 


Hysterical  Stigmata  —  Suggestibility      291 

Besides,  there  are  other  circumstances  in  which  the 
hysterical  recovers,  at  least  partially,  for  it  is  a  very 
changeable  malady.  In  certain  periods  of  rest,  of 
health,  in  certain  somnambulisms,  or  in  that  which  has 
been  wrongly  called  the  second  state  of  Felida,  we  have 
seen  that  the  hysterical  states  disappear.  You  will 
likewise  recognize  that  the  suggestibility  disappears. 
This  symptom  only  reappears  in  a  state  of  depression, 
together  with  all  the  other  accidents.  I  described,  long 
ago,  those  women  who  are  suggestible  only  three  days 
a  month,  during  their  menstrual  period.  Experimental 
suggestion  has  never  existed  with  any  persons  but  with 
hystericals. 

By  the  side  of  this  experiment  you  may  place  real 
non-experimental  suggestions,  which  occur  accidentally 
and  are  often  the  cause  of  accidents.  I  mean  those 
accidents  with  which  the  patients  are  inspired  by  the 
events  of  their  lives,  and  which,  by  developing  themselves 
to  an  exaggerated  degree,  bring  about  attacks,  paralytic 
accidents,  or  singular  visceral  diseases.  Malebranche 
related  in  the  seventeenth  century  the  story  of  a  woman 
who,  because  she  had  seen  a  rider  dragged  by  the  foot, 
had  a  disease  and  a  paralysis  in  her  foot.  We  con- 
tinually see  facts  of  this  kind  nowadays.  One  patient 
has  an  amaurosis  in  her  left  eye  because  she  has  seen 
a  child  with  scabs  on  its  left  eye,  and  another  vomits 
incessantly  because  he  has  nursed  a  cancer  of  the 
stomach.  In  all  these  cases,  if  you  examine  the  evo- 
lution of  the  disease,  its  symptoms,  the  accidents  that 
preceded  it,  I  do  not  hesitate  to  assure  you  that  you  will 
always  find  again  the  same  neurosis. 


292      The  Major  Symptoms  of  Hysteria 

In  a  word,  my  opinion  on  this  point  has  become 
more  and  more  definite.  Suggestion  is  a  precise  and 
relatively  rare  phenomenon ;  it  presents  itself  experi- 
mentally or  accidentally  only  with  hystericals,  and, 
inversely,  all  hystericals,  when  we  study  them  from 
this  standpoint,  present  this  same  phenomenon  in  a 
higher  or  lower  degree.  If  we  add  that,  as  we  shall  see 
later,  this  psychological  fact  plays  a  great  r61e  in  the 
formation  of  their  disease,  we  may  say  that  the  most 
important  mental  stigma  of  hysteria  is  suggestibility. 
We  have  still  to  ask  ourselves  whether  there  are  not 
other  mental  stigmata  to  be  added  to  this  one. 


V 


LECTURE  XIV 

THE  HYSTERICAL  STIGMATA  — THE  RETRAC- 
TION OF  THE  FIELD  OF  CONSCIOUSNESS  — 
THE  COMMON  STIGMATA 

Other  proper  hysterical  stigmata  —  Absent-mindedness  — 
The  contraction  of  voluntary  movements  —  Subconscious- 
ness  —  Transfers  and  equivalences  —  Alternation  —  The 
elementary  phenomena  of  consciousness  —  Personal  percep- 
tion —  Conscious  synthesis  —  The  field  of  consciousness  — 
7/5  variations  —  The  retraction  of  the  field  of  conscious- 
ness —  The  common  stigmata  —  The  feelings  of  incom- 
pleteness —  The  need  of  excitation  —  The  need  of  attract- 
ing attention  —  Lapses  of  the  mental  functions  —  The 
weakness  of  attention  —  Emotional  disturbances  —  Troubles 
of  the  will  —  The  incapacity  of  beginning  or  of  stopping 
—  The  lowering  of  the  mental  level 

THE  r61e  played  by  suggestion  in  hysteria  is  beginning 
to  be  known,  and  I  shall  no  longer  raise  too  many 
protestations  by  presenting  to  you  suggestion  as  a  hys- 
terical stigma;  but  I  think  it  is  well  to  go  farther. 
We  should  not  explain  the  whole  of  this  so  complex 
disease  by  this  single  phenomenon.  For  the  present, 
I  confine  myself  to  remarking  that,  in  the  mental  dis- 
positions of  these  patients,  there  are  to  be  found  other 
facts  of  at  least  equal  importance.  These  other  funda- 
mental phenomena  are  also  stigmata  to  my  mind. 
Only  I  propose  to  you  to  divide  them  into  two  classes. 

293 


294      The  Major  Symptoms  of  Hysteria 

Among  these  stigmata,  some  deserve  to  be  called  proper; 
they  have  the  same  properties  as  suggestion  itself. 
They  are  phenomena  that  exist  in  hysteria,  but  scarcely 
exist  in  any  other  disease.  The  others  might  be  called 
common  stigmata,  for  the  following  reason.  No  doubt, 
they  present  themselves  among  hystericals,  and  often 
in  a  high  degree,  but  they  do  not  exist  solely  among 
these  patients,  and  they  are  to  be  found  in  other  mental 
affections,  in  particular  in  the  psychasthenic  neuroses, 
which  are  closely  akin  to  hysteria,  though  different 
from  it.  Let  us  dwell  on  the  other  stigmata  proper, 
which  are  added  to  suggestion,  and  devote  a  few  words 
to  the  common  stigmata,  which  allow  us  to  connect  the 
neurosis  we  consider  with  the  other  disturbances  of 
the  mind. 


Suggestion,  let  us  not  forget,  is  the  development  of 
an  idea ;  it  implies  a  positive  phenomenon,  the  presence 
of  an  idea  in  the  mind  of  the  subject.  We  cannot  con- 
nect with  suggestion  things  that  take  place  without  the 
subject's  being  at  all  aware  of  them,  without  his  realizing 
them  either  consciously  or  subconsciously.  Now,  I  do 
not  believe  that  everything  in  hysteria  is  in  relation 
with  the  thought  of  the  subject.  There  are  in  these 
patients  attitudes,  dispositions  that  not  only  are  not 
intentional  but  that  are  in  relation  with  no  thought  of 
the  patients. 

I  should  like  to  put  in  the  first  rank  of  these  phenom- 
ena a  very  singular  disposition  of  mind,  for  which  we 
have  not  even  a  very  clear  expression ;  namely,  a  dis- 


The  Hysterical  Stigmata  295 

position  to  indifference,  to  abstraction,  to  quite  ex- 
aggerated absent-mindedness.  The  fact  is  this:  while 
paying  attention  to  something,  we  turn  from  some  other 
thing  and  cease  to  interest  ourselves  in  other  phenomena, 
which  however  reach  our  minds.  While  I  am  paying 
attention  to  what  I  am  reading,  I  abstract  myself  from 
the  noises  in  the  street,  though  I  still  perceive  them. 
This  abstraction  exists  in  hysteria  in  an  astonishing 
degree.  It  was  noticed  early  that  it  presents  itself  in 
regard  to  the  sensations  and  to  ideas.  These  patients 
appear  to  see  but  one  thing  at  a  time,  and  you  become 
aware  that  they  have  no  notion  of  another  object, 
though  it  be  very  near  the  first.  When  they  speak 
to  one  person,  they  forget  that  there  are  others  in  the 
room.  They  forget  them  so  entirely  that  they  would 
tell  all  their  secrets  before  them  with  indifference. 
When  they  express  some  idea,  you  notice  that  their 
conviction  is  childish.  It  seems  very  strong  because 
it  rests  on  an  astonishing  ignorance.  Objections, 
impossibilities,  contradictions,  do  not  reach  their  minds 
in  the  least. 

The  same  limitation  was  observed  in  their  move- 
ments from  the  first.  They  can  perform  but  one  action 
at  a  time.  The  first  indication  you  perceive  of  a  mental 
disturbance  with  many  girls  is  their  incapacity  to  do, 
in  spite  of  their  good-will,  more  than  one  errand  at  a 
time.  This  fact  may  even  be  made  in  some  sort  experi- 
mental. Here  is  an  experiment  that  I  have  described 
under  many  forms l  and  that  M.  Pick,  of  Prague, 

1  "  L'Automatisme  Psychologique,"  1889,  p.  188  et  seq.  "The 
Mental  State  of  Hystericals,"  English  translation,  p.  161. 


296      The  Major  Symptoms  of  Hysteria 

has  developed.1  You  ask  one  of  these  patients  to  make 
a  certain  movement  continually,  for  instance  to  make 
on  the  table  with  her  right  hand  the  movement  of  playing 
on  the  piano.  It  is  agreed  that  she  must  not  discontinue 
this  little  movement,  whatever  may  happen.  At  the 
same  time,  you  ask  her  to  perform  some  other  simple 
acts,  to  open  her  mouth,  to  shut  her  mouth,  to  recite 
numbers.  You  always  remark  that  the  first  movement, 
the  piano  playing,  stops  as  soon  as  the  second  begins, 
and  that  it  only  recommences  at  the  end  of  this  second 
movement.  Yet  the  subject  had  made  up  her  mind  to 
continue  this  movement,  she  had  this  idea  in  her  head, 
but  it  became  impossible  for  her  as  soon  as  she  tried  to 
do  something  else. 

It  is  this,  besides,  that  gives  a  special  appearance  to  all 
their  accidents.  By  the  side  of  the  positive  phenom- 
enon, consisting  in  the  development  of  the  somnambulic 
idea,  in  convulsions,  in  persistent  emotions,  there  was 
a  kind  of  lacuna,  a  complete  oblivion  of  the  present 
situation,  an  indifference  to  ridicule,  an  insensibility 
to  fatigue,  all  of  which  we  should  not  have  had  in  their 
place.  One  would  think  that  these  subjects,  when  once 
ill,  forget  all  that  is  outside  their  present  accident. 
They  do  not  remember  having  been  in  another  state, 
they  do  not  conceive  that  one  can  be  in  another  state. 
Hence  that  resignation,  that  absence  of  effort,  which 
surprised  us. 

The  exaggeration  of  this  disposition  will  bring  about 
the  phenomenon  of  subconsciousness :  a  great  many 

1  A.  Pick,  "  Ueber  die  Sogenannte  'Conscience  Musculaire/" 
Zeitschrijt  jiir  Physiologic  der  Sinnesorgane,  IV,  1892. 


The  Hysterical  Stigmata  297 

things  will  exist  outside  the  personal  consciousness. 
You  will  be  able  to  make  the  patients  walk  and  act 
unknown  to  themselves.  If  the  ideas  you  express  do 
not  attract  their  attention  and  if  they  remain  in  that 
domain  of  absent-mindedness,  it  will  result  in  medium- 
ship,  as  we  saw  before  that  the  development  of  the 
ideas  results  in  great  somnambulisms. 

Can  we  say  that  this  disposition  to  exaggerated  absent- 
mindedness  is  a  consequence  of  the  preceding  symptom 
of  suggestion  ?  In  fact,  it  is  not  so,  for  absent-minded- 
ness is  not  suggested  to  these  patients  and  often  is  not 
even  noticed.  They  have  not  the  idea  of  this  phenom- 
enon, the  importance  of  which  they  do  not  suspect. 
This  singular  absent-mindedness  is  mostly  noticed  by 
those  around  them,  or  by  themselves  only  very  late, 
several  years  after  it  has  begun  to  develop  itself.  On 
the  other  hand,  it  is  difficult  to  understand  how  sug- 
gestion, which  is  precisely  the  development  of  an  idea, 
could  explain  this  absent-mindedness,  which  is  indif- 
ference to  an  idea,  a  tendency  to  suppression.  Lastly, 
suggestion  itself  appears  to  me  to  depend  on  that 
disposition,  and  to  be  much  oftener  its  effect  than  its 
cause.  It  is  precisely  because  the  subjects  have  for- 
gotten everything,  because  they  are  no  longer  restrained 
by  any  sensation,  by  any  thought  relative  to  the  reality 
that  surrounds  them,  that  they  allow  the  ideas  suggested 
to  them  to  develop  freely.  Suggestion  and  absent- 
mindedness  do  not  produce  each  other,  they  are  two 
parallel  stigmata,  one  of  which  cannot  exist  without 
the  other. 

This  special  absent-mindedness  is  a  stigma  peculiar 


298      The  Major  Symptoms  of  Hysteria 

to  hysteria.  First  of  all,  you  do  not  find  it  in  the  normal 
individual.  Normal  consciousness,  as  philosophers 
say,  is  always  a  fully  illuminated  point,  surrounded  by 
a  strong  penumbra.  With  the  hysterical,  the  penumbra 
is  wanting.  This  fact  is  brought  into  evidence  by  their 
quite  peculiar  visual  field ;  you  do  not  find  in  any  normal 
individual  that  odd  vision,  which  sees  very  clearly 
in  one  point  and  sees  nothing  around  this  point.  Nor 
is  this  absent-mindedness  to  be  met  with  in  the  same 
fashion  in  the  other  maladies  of  the  mind.  Individuals 
who  are  tired  are  inattentive,  but  their  minds  are  vaguely 
on  the  stretch.  No  doubt,  they  search  into  nothing, 
but  they  have  a  vague  notion  of  everything.  Their 
sensibility  is  attenuated,  I  grant,  but  it  is  distributed 
over  the  whole  of  their  body.  Their  vision  is  di- 
minished, but  their  visual  field  remains  broad.  In  a  word, 
the  symptom  I  wish  to  describe  to  you  is  not  inattention ; 
it  is  a  suppression  of  all  that  is  not  looked  at  directly, 
and  I  do  not  believe  that  it  is  to  be  found  in  this  form 
in  the  other  diseases  of  the  mind.  So  I  make  it  a  stigma 
proper  to  hysteria  as  suggestion  itself. 

A  third  phenomenon,  which,  besides,  depends  on  the 
preceding  ones,  will  make  you  understand  these  strange 
stigmata  still  better.  It  is  the  phenomenon  of  transfers 
and  equivalences.  I  was  seeking  one  day  to  cure  a  small 
localized  accident,  to  restore  the  motion  of  the  right 
wrist  with  a  patient  whose  fist  was  contractured.  You 
know  that,  to  succeed,  one  must  strongly  direct  the 
attention  of  the  subject  to  the  diseased  organ,  which 
she  has  forgotten,  determine  sensations  in  it,  move 
it  passively  in  every  way;  then,  when  the  motion  has 


The  Hysterical  Stigmata  299 

been  a  little  restored,  induce  the  subject  voluntarily  to 
move  this  wrist.  This  work  is  long  and  troublesome, 
and  has  to  be  begun  over  and  over  again  with  hystericals. 
When  it  has  proceeded  for  some  time,  the  result  seemed 
marvellous;  the  right  hand  had  opened  and  moved 
freely  in  every  way,  the  patient  left  the  laboratory  very 
happy  and  proud.  She  reentered  it  a  few  moments 
later  in  despair.  "It  was  not  worth  while  making  such 
efforts,"  she  said,  presenting  her  left  fist,  which  was 
contractured  exactly  in  the  same  way  as  her  right  fist 
had  been  a  few  minutes  before.  I  have  cited  this  ad- 
venture because  it  struck  me  by  the  circumstances  in 
which  it  occurred ;  namely,  in  a  quite  na'ive  patient, 
having  no  notion  of  the  phenomenon,  and  without  the 
operator  or  herself  having  had  the  least  idea  of  it,  before- 
hand. 

You  know  that  the  result  is  not  always  like  that. 
During  a  certain  period,  from  1875  to  1890,  this  phenom- 
enon, which  is  called  transfer,  was  very  much  sought 
after  and  often  provoked  artificially.  It  was  said  to 
be  brought  about  by  the  mechanical  action  of  certain 
substances.  Thus  the  magnet  had  preeminently  the 
power  of  provoking  transfers.  To  cure  a  paralysis 
of  the  right  side,  a  big  magnet  was  placed  in  the  bed 
of  the  patient,  near  her  right  side.  The  paralysis  was 
then  found  to  disappear  on  that  side  and  to  become 
localized  on  the  left  side.  When  the  magnet  was  with- 
drawn, the  paralysis  reappeared  on  the  right  side,  and, 
after  several  oscillations  of  this  kind,  it  vanished. 
Other  substances  —  metals  in  particular,  sometimes  the 
electric  current  —  had  similar  effects,  and  transferred 


300      The  Major  Symptoms  of  Hysteria 

symmetrically  from  one  side  to  the  other  the  disturbances 
of  sensibility  as  well  as  those  of  motion.  You  remember 
that  this  phenomenon  was  very  much  studied  by  Burcq 
and  Dumontpallier,  who  ascribed  to  it  very  odd  laws. 
Some  physicians  said  they  had  found  the  means  to  make 
the  oscillations  either  slow  or  rapid,  to  fix  the  disturb- 
ance on  one  side  or  the  other,  etc.  Others  went  even 
further;  they  invented  the  change  of  the  colour  sensa- 
tions, which  were  transformed  into  their  complementary 
colours.  The  patients,  after  having  seen  red,  saw 
green ;  after  having  seen  yellow,  they  saw  violet.  They 
called  this  polarization,  and,  by  means  of  the  magnet, 
tried  to  polarize  also  the  feelings.  Lastly,  —  for  absurd- 
ity has  no  limits,  —  they  tried  to  transfer  a  phenomenon 
from  one  subject  to  the  other ;  they  placed  two  subjects 
back  to  back,  and,  thanks  to  the  magnet,  the  paralysis 
of  the  first  passed  into  the  second,  and,  after  a  few  os- 
cillations, disappeared.  It  became  a  convenient  thera- 
peutic process. 

No  doubt  there  are  in  all  this  many  childish  errors. 
Many  of  these  observations  are  phenomena  of  suggestion 
and  training,  they  depend  on  the  direction  that  is 
given  to  the  attention  of  the  subject.  This  could  not 
but  be  gradually  recognized,  so  that,  in  science  as  in 
politics,  we  saw  a  violent  reaction.  The  very  notion  of 
the  phenomenon  of  transfer  was  suppressed,  and  the 
fact  that  there  is  some  little  truth  in  it  was  overlooked. 
In  my  opinion,  this  passage  of  an  accident  from  one  side 
to  the  other  is  not  necessarily  the  result  of  a  suggestion. 
It  sometimes  takes  place  unknown  to  the  subject  and 
to  the  operator,  and  that  very  naturally. 


The  Hysterical  Stigmata  301 

It  is  a  particular  application  of  a  disposition  which  is 
very  general  with  the  hysterical,  and  of  which  a  thou- 
sand other  applications  are  to  be  observed;  namely, 
the  disposition  to  equivalences .  Hysteria,  in  fact,  is  a 
very  singular  malady,  the  cure  of  which  one  never  dares 
assert.  It  is  often  easy,  through  some  psychological 
process  or  other,  to  cause  such  or  such  a  determinate 
accident  to  disappear.  Besides,  these  accidents  often 
disappear  of  themselves,  in  consequence  of  an  emotion, 
of  some  shake,  or  even  without  reason.  But,  when  an 
accident  has  disappeared,  especially  when  it  has  dis- 
appeared too  quickly,  we  should  not  at  once  cry  out 
victory.  First  of  all,  the  same  accident  is  very  likely 
to  soon  reappear.  Then  the  following  strange  thing 
very  frequently  occurs:  another  apparently  quite  dif- 
ferent accident  takes  the  place  of  the  first.  A  girl  of 
twelve  presented  incoercible  vomitings,  which  had 
brought  her  to  a  very  serious  state  of  inanition.  Thanks 
to  certain  excitations  of  the  sensibility  during  a  sornnam- 
bulic  state,  I  succeed  in  making  her  eat  with  more 
sensibility,  in  regularizing  her  deglutitions,  and  she  no 
longer  vomits.  This  seems  all  right,  but,  from  that 
moment,  this  girl,  till  then  perfectly  intelligent,  enters 
into  a  state  of  mental  confusion  and  delirium,  and  it 
becomes  impossible  to  stop  this  delirium  without  the 
vomitings  beginning  again.  Let  us  remark  by  the  way 
that  this  singular  alternation  between  disturbances  of 
the  stomach  and  deliriums  is  one  of  those  that  are  oftenest 
observed.  I  have  noted  down  five  fine  examples  of 
them. 

But  other  identical  facts  are  to  be  observed.     One 


3<D2      The  Major  Symptoms  of  Hysteria 

patient  has  contractures  in  her  limbs,  and,  when  the 
contractures  disappear,  mental  disturbances;  another 
has  hysterical  coughing,  and,  alternating  with  it,  crises 
of  sleep.  A  man  had  a  foot  contractured  in  the  position 
called  varus.  He  was  cured  through  somewhat  mys- 
terious processes,  which  frightened  him.  He  could 
now  walk  freely,  but  he  lost  his  voice  for  three  months. 
When  his  voice  returned,  he  had  gastric  accidents  and 
abdominal  contractures.  In  another  case,  the  con- 
tractures of  the  trunk  were  healed  and  replaced  by 
phenomena  of  amaurosis.  And  so  on  indefinitely. 
The  accidents  seem  to  be  equivalent  and  to  have  the 
property  of  bearing  on  one  side  or  the  other,  provided 
they  exist  somewhere.  You  would  think  that  the  sub- 
ject can  choose  but  cannot  do  without  a  disturbance 
localized  in  some  place  or  other.  If  you  understand 
this  law  of  equivalences  well,  you  will  see  that  the 
transfer  from  the  right  side  to  the  left  side  is  but  a 
particular  case  of  it.  It  is  even  a  particularly  simple 
form  of  equivalence,  for  the  sensations  of  the  sym- 
metrical parts  are  very  similar  and  can  very  easily 
be  replaced  by  one  another. 

No  doubt,  in  many  diseases  of  the  mind,  we  observe 
instability,  but  this  quite  special  form  of  instability 
which  replaces  one  definite  accident  by  another  ap- 
parently quite  different,  and  that  suddenly  and  clearly, 
is,  again,  very  characteristic.  I  think  it  results  from  a 
general  disposition  of  the  hysterical  mind,  which  urges 
it  to  move  in  its  entirety  to  one  side,  while  neglecting  the 
rest  of  the  body  and  mind,  then  to  move  in  its  ensemble 
in  another  direction,  while  forgetting  the  first.  This 


The  Hysterical  Stigmata  303 

is  connected  with  the  preceding  phenomenon  of  sug- 
gestion, and  constitutes  the  last  of  the  stigmata  peculiar 
to  hysteria  that  I  wished  to  point  out  to  you. 


II 

Can  we  summarize  these  three  stigmata,  suggestion, 
absent-mindedness,  and  alternation,  into  a  single 
general  idea  that  will  enable  us  to  conceive  the  essential 
character  which  manifests  itself  in  these  mental  troubles  ? 
I  proposed  formerly  to  characterize  this  mental  state 
by  an  expression  that  is  perhaps  singular,  but  that  may 
be  serviceable.  You  will  find  it  in  my  work  on  the 
psychological  automatics  in  1889  and  in  my  book  on 
"  The  Mental  State  of  Hystericals,"  1894,  which  was  very 
well  translated  into  English  by  Mrs.  C.  Rollin  Corson 
in  1901.  I  proposed  to  summarize  this  somewhat 
peculiar  mental  state  by  the  words  "retraction  of  the 
field  o]  consciousness."  Let  us  try  to  understand  the 
meaning  of  this  general  expression. 

The  word  "consciousness,"  which  we  use  continually 
in  studies  on  the  mental  state  of  our  patients,  is  an 
extremely  vague  word,  which  means  many  different 
things.  When  we  use  it  in  particular  to  designate  the 
knowledge  the  subject  has  of  himself,  of  his  sensations 
and  acts,  it  means  a  rather  complicated  psychological 
operation,  and  not  an  elementary  and  irreducible  opera- 
tion, as  is  generally  believed.  If  I  say,  for  instance,  "  I 
feel  a  pain,  I  feel  that  I  move  my  arm,"  there  take  place 
in  my  mind  rather  complicated  phenomena,  which  we 
can  analyze  in  the  following  manner.  In  the  first  place, 


304      The  Major  Symptoms  of  Hysteria 

there  occurs  somewhere  in  my  brain,  on  the  occasion  of 
an  outer  excitation,  a  small  fact,  both  physiological 
and  psychological,  which  corresponds  to  a  phenomenon 
of  pain,  to  an  elementary  sensation  of  motion.  The 
great  physiologist  Herzen  said  that  the  brain  may  be 
compared  to  a  spacious  hall  filled  with  innumerable 
small  electric  lamps.  From  time  to  time,  certain  little 


FIG.  21.  —  T  T'  T",  elementary  sensations  of  touch;  M  M'  M",  of  mus- 
cular sense;  V  V  V",  of  vision;  A  A'  A",  of  audition;  P  P,  personal 
perception. 

lamps  kindle  here  and  there.  This  is  what  is  des- 
ignated by  the  isolated  words,  "sensation  of  pain," 
"sensation  of  vision,"  "sensation  of  motion."  In  the 
scheme  I  have  drawn  (Figure  21),  each  separate  little 
cross  of  the  upper  line  designates  one  of  those  little  phe- 
nomena, V)  V,  V",  when  it  is  a  question  of  the  vision, 
T,  Tf,  T",  when  it  is  a  question  of  the  sensations  of 
touch,  and  so  on. 

But  the  complete  consciousness  which  is  expressed 
by  the  words,  "I  see,  I  feel  a  movement,"  is  not  com- 


The  Hysterical  Stigmata  305 

pletely  represented  by  this  little  elementary  phenomenon. 
It  contains  a  new  term,  the  word  "I,"  which  designates 
something  very  complicated.  The  question  here  is 
of  the  idea  of  personality,  of  my  whole  person ;  it  is 
the  union  of  present  sensations  different  from  the  little 
sensation  considered,  from  all  past  impressions,  from 
the  imagination  of  future  phenomena.  It  is  the  notion 
of  my  body,  of  my  capacities,  of  my  name,  of  my  social 
position,  of  the  part  I  play  in  the  world ;  it  is  an  ensemble 
of  moral,  political,  religious  thoughts.  It  is  a  world  of 
ideas,  the  most  considerable,  perhaps,  that  we  can  ever 
know,  for  we  are  far  from  having  made  the  tour  of  the 
domain  of  personality.  There  are  then  in  the  "I  feel," 
two  things  in  presence  of  each  other:  a  small,  new, 
psychological  fact,  a  little  flame  lighting  up  —  "feel "  — 
and  an  enormous  mass  of  thoughts  already  constituted 
into  a  system  —  "L"  These  two  things  mingle, 
combine;  and  to  say  "I  feel"  is  to  say  that  the  already 
enormous  personality  has  seized  upon  and  absorbed 
that  little,  new  sensation  which  has  just  been  produced. 
If  we  dared,  and  it  is  not  altogether  absurd,  we  should 
say  that  the  "I"  is  a  living  animal,  extremely  voracious, 
a  sort  of  amoeba,  which  sends  out  tentacles  to  seize 
and  absorb  a  very  small  creature  which  has  just  been 
born  at  its  side. 

After  having  represented  in  the  first  line  of  our 
schema  the  elementary  sensations,  or  affective  states, 
or  simply  subconscious  phenomena,  we  represent, 
secondly,  a  reunion,  a  synthesis  of  all  these  elementary 
phenomena  which  are  combined  among  themselves, 
and  particularly  combined  with  the  vast  and  prior 


306      The  Major  Symptoms  of  Hysteria 

notion  of  personality.  It  is  only  after  this  sort  of 
assimilation  that  we  can  truly  say,  "I  feel."  I  formerly 
proposed  to  designate  this  new  operation  by  the  name 
of  personal  perception,  P.P.,  for  it  is  indeed  a  perception, 
that  is  to  say,  a  clearer  and  more  complex  consciousness. 
The  word  "personal"  will  prevent  confounding  this 
operation  with  the  outward  perception,  of  which  we  do 
not  treat  here,  and  will  recall  to  mind  that  its  essential 
character  is  the  addition  of  the  notion  of  personality. 

This  figure  is,  of  course,  quite  theoretical,  for  it  sup- 
poses an  absurd  thing;  namely,  that  a  man  becomes 
at  a  given  moment  conscious  of,  assimilates  to  his  per- 
sonality, all  the  elementary  sensations  that  are  born 
in  all  his  senses.  Think  what  enormous  masses  of 
phenomena  must  spring  up  in  us  constantly  from  all 
the  points  of  our  body,  from  the  crowd  of  impressions 
made  on  our  skin,  on  our  mucous  membranes,  on  the 
organs  of  our  senses,  by  all  the  outer  and  inner  phe- 
nomena. It  is  certain  that  a  man  never  perceives  them 
all.  There  are  always,  even  in  the  most  normal  man, 
a  quantity  of  impressions  that  are  born  in  one  point 
of  the  skin,  reach  to  the  brain,  determine  a  few  re- 
flexes, awake  perhaps  a  few  little  states  of  elementary 
consciousness,  contribute,  no  doubt,  to  his  general  state 
of  well-being  or  discomfort,  but  are  not  clearly  per- 
ceived by  his  personality.  A  part  only  of  these  ele- 
mentary sensations  gives  rise  to  complete  and  personal 
perception. 

What  is  the  number  of  those  elementary  phenomena 
that  rise  to  complete  consciousness  ?  Of  how  many  ele- 
mentary sensations  can  we  simultaneously  have  the 


The  Hysterical  Stigmata  307 

complete  consciousness?  This  is  what  I  proposed  to 
call  the  problem  of  the  extent  of  the  field  of  conscious- 
ness, by  analogy,  as  you  see,  with  the  extent  of  the  visual 
field.  This  problem  is  not  clearly  resolved,  and  psy- 
chologists have  proposed  very  different  figures. 

The  only  essential  and  certain  thing  is  that  this  extent 
of  the  field  of  consciousness  varies  very  much  with 
individuals  and  their  states  of  mind.  An  orchestral 
conductor,  hearing  simultaneously  all  the  instruments, 
and  following  by  reading  or  by  memory  the  score  of  the 
opera,  unites  in  each  of  his  states  of  consciousness 
an  immense  number  of  facts.  The  individual  who, 
when  asleep,  dreams,  and  the  patient  during  a  crisis  of 
ecstasy,  have,  on  the  contrary,  in  their  conscious  thought 
a  very  limited  number  of  facts.  I  think  there  are  on  this 
point  perpetual  and  very  nice  variations  of  our  mental 
state. 

If  you  understand  this  psychological  conception  well, 
you  can  easily  apply  it  to  the  preceding  phenomenon 
that  we  have  just  noted  with  our  hysterical  patients. 
Their  first  moral  stigma,  suggestion,  already  shows  us 
the  isolation  of  the  ideal;  it  is  because  there  is  no  re- 
action between  the  various  impressions  that  each  word, 
each  emotion,  each  remembrance,  takes  an  inordinate 
development  which  we  called  suggestibility.  Sug- 
gestion, it  is  always  said,  depends  on  the  absence  of 
control.  But  control  is  nothing  but  the  struggle,  the 
competition  of  the  various  psychological  states  united 
in  the  same  consciousness.  If  it  is  wanting,  it  is 
because  the  mind  is  too  narrow  to  contain  several  ideas 
opposing  one  another.  The  second  characteristic, 


308      The  Major  Symptoms  of  Hysteria 


exaggerated  absent-mindedness,  that  abstraction  bring- 
ing on  all  the  blanks  of  consciousness,  is  but  another 
aspect  of  the  same  phenomenon. 

Our  schema  gives  us  the  formula  perfectly.    Let 
us  suppose  (Figure  22)  an  individual  who  cannot  see,  at 


£ 


$ 


A' 


A' 

4- 


FIG.  22.  — Schema  of  absent-mindedness. 

a  given  moment,  more  than  three  elementary  sensations, 
such  as  V,  V,  A .  He  will  leave  all  the  rest  in  his  sub- 
consciousness.  At  another  moment,  he  will  be  able 
to  turn  to  T,  Tr,  V,  or  to  M ,  V,  A .  At  the  first  moment, 
he  will  look  at,  and  listen  to,  a  person  who  speaks  to  him, 
without  troubling  about  the  tactile  sensations  which 
continue  to  assail  him.  At  the  second  moment,  he  will 


The  Hysterical  Stigmata  309 

look  at  an  object  while  touching  it,  and  appreciate  the 
contact  without  having  consciousness  of  the  surrounding 
noises.  At  the  third  moment,  he  will  write  at  dictation, 
having  the  perception  of  the  sound  of  the  voice,  of  the 
vision  of  the  letters  and  of  the  muscular  movements,  but 
forgetting  and  neglecting  all  the  other  elementary 
sensations,  as  T,  T',  T" ,  M',  M",  V,  V",  A',  A".  This 
individual  is  absent-minded,  and  this  (Figure  22)  is  an 
attempt  to  schematize  what  is  called  normal  absent- 
mindedness. 

Let  us  suppose  that  the  field  of  consciousness  becomes 
still  more  contracted.  The  patient  can  no  longer 
perceive  more  than  two  elementary  sensations  at  once. 
Of  necessity  too,  he  reserves  this  small  share  of  per- 
ception for  the  sensations  which  seem  to  him,  whether 
right  or  wrong,  the  most  important,  the  sensations 
of  sight  and  hearing.  To  have  consciousness  of  what 
is  seen  or  heard  is  of  paramount  necessity,  and  he 
neglects  to  perceive  the  tactile  and  muscular  sensations, 
thinking  he  can  do  without  them  (Figure  23).  At  the 
outset,  he  might  perhaps  still  turn  to  them  and  take 
them  into  his  field  of  personal  perception,  at  least  for 
a  moment;  ,but,  the  chance  not  presenting  itself,  the 
bad  psychological  habit  is  slowly  formed.  Nothing  is 
more  serious,  more  obstinate  than  these  moral  habits. 
There  is  a  crowd  of  maladies  that  are  only  psychological 
tics.  One  day  the  patient  (for  he  has  truly  become 
one  now)  is  examined  by  the  physician.  The  latter 
pinches  his  left  arm,  and  asks  him  if  he  feels  it,  and  the 
patient,  to  his  great  surprise,  is  obliged  to  confess  that 
he  can  no  longer  feel  consciously.  The  too  long-neg- 


310      The  Major  Symptoms  of  Hysteria 


lected  sensations  have  escaped  his  personal  perception ; 
he  has  become  anesthetic. 

You  may  easily  understand  that  the  same  notion  of 
the  contraction  of  the  field  of  consciousness  equally 

T          T'        T"       M        M'       M"       V         V'        V"      A 


T' 


M 

-t- 


T' 

•*- 


M 


FIG.  23.  — Schema  of  the  contraction  of  the  field  of  consciousness  in 
hysterical  anesthesia. 

sums  up  the  last  phenomenon,  that  of  alternations.  It 
is  because  the  field  of  consciousness  remains  contracted, 
that  you  can  never  add  one  phenomenon  on  one  side 
without  taking  one  away  from  another  side.  If  you 
force  the  subject,  by  attracting  his  attention,  to  recover 


The  Hysterical  Stigmata  311 

the  sensibility  of  the  left  side,  he  loses  it  on  the  right  side. 
If  you  obtain  the  total  tactile  sensibility,  the  reduction  of 
the  visual  field  increases  so  much  that  the  subject 
becomes  momentarily  blind,  a  thing  we  have  observed 
a  number  of  times  without  having  foreseen  it.  If  you 
wish  to  enlarge  the  visual  field,  the  tactile  anesthesia 
will  increase.  The  feebleness  of  these  patients'  thinking 
continues,  and  they  lose  on  one  side  what  they  seem  to 
have  regained  on  another. 

I  am  therefore  inclined  to  think  that  this  notion  of  the 
retraction  of  the  field  of  consciousness  summarizes  the 
preceding  stigmata,  and  we  may  say  that  their  funda- 
mental mental  state  is  characterized  by  a  special  moral 
weakness,  consisting  in  the  lack  of  power,  on  the 
part  of  the  feeble  subject,  to  gather,  to  condense  his 
psychological  phenomena,  and  assimilate  them  to  his 
personality. 

Ill 

Formerly  I  stopped  at  this  point  my  description  of  the 
hysterical  mental  state,  implying  that  all  the  other 
disturbances  of  their  character  could  be  connected 
with  the  preceding  ones.  It  no  longer  seems  to  me 
absolutely  true  to-day.  The  hysteric  malady  is  not 
absolutely  isolated,  like  other  mental  disturbances.  It 
is  a  special  form,  which  constitutes  a  part  of  a  much  more 
considerable  group,  and  which  is  more  or  less  distin- 
guished from  the  other  diseases  belonging  to  this  group. 
The  patients  we  consider  are  first  and  above  all  neuro- 
paths, individuals  whose  central  nervous  system  is 
weakened;  then  they  are  hystericals,  when  their  en- 


312      The  Major  Symptoms  of  Hysteria 

feeblement  takes  a  particular  form.  I  even  affirm  that 
they  are  more  or  less  hysterical  according  as  their  malady 
takes  a  more  or  less  decided  turn  in  this  determinate 
direction.  The  result  is  that,  besides  the  properly 
hysterical  stigmata,  they  have  general  vague  disturb- 
ances, at  once  psychological  and  physiological,  which 
belong  to  all  neuropathic  individuals.  We  cannot  enter 
into  the  enumeration  of  these  disturbances,  which, 
besides,  would  be  more  interesting  in  connection  with 
other  subjects,  but  we  must  indicate  them  shortly  under 
the  title  of  common  stigmata  which  you  understand  now. 

I  will  point  out  to  you  in  this  connection  certain  feel- 
ings that  play  a  r61e  in  the  popular  conception  of  hysteria. 
These  subjects  feel  weak,  dissatisfied  with  themselves; 
their  actions,  ideas,  feelings,  appear  to  them  reduced, 
covered  with  a  kind  of  veil.  They  are,  therefore,  per- 
petually tormented  by  a  vague  ennui  which  they  cannot 
overcome.  Ennui  is  the  great  stigma  of  all  neuropaths. 
You  must  not  believe  that  it  depends  on  surroundings; 
the  neuropath  feels  dull  everywhere  and  always,  for 
no  impression  any  longer  brings  about  with  him  lively 
thoughts  that  make  him  pleased  with  himself. 

These  general  sentiments  of  dissatisfaction,  these 
sentiments  of  incompleteness,  as  I  have  christened  them 
elsewhere,1  almost  always  give  to  the  patient  a  peculiar 
attitude  or  conduct.  Either  he  is  sunk  in  despondency 
and  exhibits  a  doleful  air,  or  he  seeks  everywhere  for 
something  that  can  draw  him  out  of  this  state.  Now 
he  has  but  very  few  means  at  his  disposal  to  rouse 
himself,  to  come  out  of  such  a  painful  state.  Either 
1  "  Obsessions  et  psychasth^nie,"  1903,  I,  p.  264. 


The  Hysterical  Stigmata  313 

he  will  use  physical  and  moral  processes  of  excitation, 
walking,  jumping,  crying,  or  he  will  appeal  to  other 
persons,  and  will  incessantly  ask  them  to  excite  him,  to 
revive  him  through  encouragements,  through  praises, 
and  especially  through  devotion  and  love. 

You  see  what  will  result  from  these  needs.  These 
patients  will  be,  at  the  same  time,  plaintive  and 
agitated,  they  will  commit  all  kinds  of  eccen- 
tricities, because  eccentricity  excites  them  and  draws 
attention  to  them.  They  must  needs  attract  atten- 
tion to  themselves,  in  order  that  people  may  take 
an  interest  in  them,  speak  to  them,  praise,  and,  above 
all,  love  them.  This  need  of  attracting  attention, 
of  being  praised  and  loved,  is  one  of  the  things  that  have 
been  most  remarked.  In  my  opinion  it  has  always 
been  wrongly  interpreted. 

First  of  all,  it  is  a  clinical  error  to  ascribe  this  char- 
acter to  hysteria.  It  sometimes  exists  in  a  very  high 
degree  with  hystericals,  but  it  is  by  no  means  a  stigma 
peculiar  to  this  malady;  it  exists  as  well  in  the  psy- 
chasthenic.  The  amorous  manias  of  doubters  and  of 
patients  laboring  under  obsessions,  their  mania  of 
jealousy,  their  need  of  attracting  attention  to  themselves, 
are  often  much  stronger  and  especially  more  enduring 
than  with  hystericals.  This  remark  has  very  often 
caused  errors  of  diagnosis. 

Besides  these  feelings  of  incompleteness,  we  might 
enumerate  with  our  hystericals,  as  with  all  neurasthenics 
whatsoever,  the  innumerable  lapses  of  all  the  mental 
functions.  We  note  in  the  intelligence  a  certain  ap- 
parent vivacity,  associated  with  a  fundamental  state  of 


314      The   Major  Symptoms  of  Hysteria 

laziness  and  especially  of  reverie.  These  patients  pay 
attention  to  nothing,  can  bear  no  mental  work.  Hys- 
teria, like  all  neuroses,  begins,  among  girls,  with  the 
cessation  of  their  studies  and  the  complete  incapacity  of 
learning  anything.  In  fact,  this  incapacity  of  attention 
brings  with  it,  as  a  consequence,  the  absence  0}  memory. 
Events  are  not  fixed  in  the  mind.  Whereas  old  remem- 
brances relating  to  periods  previous  to  the  malady  are 
well  preserved,  and  are  even  reproduced  with  an  exag- 
gerated automatism,  recent  events  pass  without  leaving 
any  trace.  It  is  a  disturbance  of  the  memory,  which  I 
have  described  under  the  name  of  continuous  amnesia.1 
It  is  frequent  with  hystericals,  but  it  is  not  proper  to 
them  and  it  must  be  considered  only  as  a  common 
stigma. 

The  same  alterations  are  found  in  the  feelings,  which 
are  weakened.  The  subjects,  who  seem  so  emotional, 
in  reality  feel  nothing  vividly.  They  are  indifferent 
to  all  new  feelings,  and  confine  themselves  to  reproduc- 
ing with  an  automatic  exaggeration  a  few  old  feelings, 
always  the  same.  Their  emotions,  which  seem  so  vio- 
lent, are  not  just ;  that  is  to  say,  they  are  not  en  rap- 
port with  the  event  that  seems  to  call  them  up.  You 
always  hear  the  same  cries,  the  same  declamations, 
whether  the  question  is  of  a  surprise  or  of  a  happy  or 
an  unfortunate  event. 

Lastly,  the  disturbances  of  their  will  are  well  known. 

The  patients  no  longer  will  or  rather  they  can  no  longer 

do  anything.     They  can  no  longer  make  up  their  minds 

to  anything,  hesitate  indefinitely  before  the  least  thing. 

1  "Ndvroses  et  Id&s  fixes,"  I,  p.  109. 


The  Hysterical  Stigmata  315 

I  think,  even,  that  they  can  no  longer  make  up  their 
minds  to  sleep,  and,  in  many  cases,  the  so  serious 
insomnia  of  neuropaths  is  a  phenomenon  of  abulia, 
for  they  cannot  even  make  up  their  minds  whether  they 
will  remain  awake  or  asleep.  Of  course,  it  is  especially 
new  actions  that  will  become  difficult  and,  for  a  long 
time,  the  patients  go  on  with  old  actions,  without  being 
able  to  stop,  before  they  enter  a  state  in  which  they  no 
longer  do  anything. 

This  incapacity  of  beginning  an  act  or  an  effort  of 
attention,  and  this  incapacity  of  stopping  it  when  it 
is  once  begun,  bring  about  the  most  serious  disturb- 
ances. Most  of  the  accidents  might  easily  have 
been  stopped  at  the  outset.  We  begin  to  dream  be- 
cause we  wish  to  do  so,  reverie  is  so  pleasant.  We 
begin  to  eat  sparingly  in  order  to  be  thin,  to  have  a 
small  waist,  and  not  to  look  like  mamma.  We  begin  an 
annoyance,  get  into  tantrums,  but  we  were  provoked  to 
it.  All  this,  as  the  patients  will  themselves  confess, 
might  have  been  very  easily  stopped  at  the  beginning; 
but  the  act  continues  more  and  more  automatically, 
and  the  patient  can  no  longer  stop  it  herself.  It  be- 
comes a  delirium,  an  anorexia,  and  an  attack.  "When 
I  have  begun  something,"  we  heard  a  patient  say, 
"I  must  go  on  with  it;  I  cannot  stop.  I  would  break 
the  windows,  kill  myself.  I  fall  into  an  idea  as  down  a 
precipice,  and  the  declivity  is  hard  to  climb  again." 

No  doubt  you  will  find  all  these  phenomena  of  abulia 
with  all  neuropaths.  But  that  is  not  a  reason  for  neg- 
lecting them  with  hystericals.  They  constitute  with 
them  common  stigmata  which  add  themselves  to  their 


316      The  Major  Symptoms  of  Hysteria 

proper  stigmata,  and,  besides,  often  assume  a  particular 
aspect  under  the  influence  of  the  latter.  It  is  easy  to 
summarize,  in  a  word,  these  general  disturbances  of 
neuropaths.  It  is  a  mental  depression  characterized  by 
the  disappearance  of  the  higher  functions  of  the  mind, 
with  the  preservation  and  often  with  an  exaggeration 
of  the  lower  functions;  it  is  a  lowering  of  the  mental 
level.  So  we  may  say,  in  short,  that  hystericals  present 
to  us  the  following  stigmata :  a  depression,  a  lowering 
of  the  mental  level,  which  takes  the  special  form  of  a 
retraction  of  the  field  of  consciousness. 


LECTURE  XV 
GENERAL  DEFINITIONS 

Review  of  the  typical  symptoms  of  hysteria  —  The  positive 
and  negative  phenomena  in  somnambulism  with  amnesia, 
in  agitations  with  paralyses  and  anesthesias  —  The  general 
idea  of  the  contraction  0}  the  field  of  consciousness  and  of 
the  lowering  of  the  mental  level  —  Definitions  of  hysteria  — 
Their  congruency  —  Psychological  definitions  —  The  need 
of  precision  in  these  definitions  —  Definitions  of  hysteria 
as  a  disease  by  suggestion  —  Discussion  of  these  defi- 
nitions —  Fixed  ideas,  without  relation  to  the  medical  form 
of  the  accident  —  The  physiological  and  psychological  laws 
unknown  to  the  patient  —  The  conditions  of  suggestion  — 
Hysteria  as  a  form  of  mental  depression,  characterized  by 
the  contraction  of  the  field  of  personal  consciousness  and 
a  tendency  to  the  dissociation  and  emancipation  of  the 
system  of  ideas  and  functions  that  constitute  personality  — 
The  laws  of  localization  —  The  part  played  by  the  diffi- 
culty of  the  junction,  by  psychological  automatism,  by  the 
anterior  weakening  of  the  junction,  by  the  localization  of  the 
emotion 

IN  these  lectures  on  the  great  symptoms  of  hysteria, 
I  have  tried  to  present  a  rapid  picture,  not  of  all  the 
symptoms  of  hysteria,  but  of  the  essential  ones,  in  order 
that  you  might  form  a  just  idea  of  a  singular  malady, 
of  which  everybody  speaks  and  which  but  few  physicians 
know  well.  I  have  only  presented  to  you  the  typical 


3i 8      The  Major  Symptoms  of  Hysteria 

cases  and  forms,  around  which  it  is  easy  for  you  to  group 
the  degraded  forms  and  confused  aspects  which  most 
diseases  offer  in  practice.  We  must  try  now  to  sum  up 
these  descriptions  and  to  derive  from  them  some  general 
conception  of  the  whole  disease. 


Allow  me,  first,  to  remind  you  in  a  few  words  of  the 
essential  pictures  you  should  keep  before  your  eyes 
in  order  to  form  a  general  idea  of  the  hysterical  disease. 
We  have  studied  somnambulism  together.  I  no  longer 
say  "  hysterical  somnambulism,"  for  there  is  no  more  any 
somnambulism  for  us,  outside  of  hysteria.  We  have 
studied  it  under  its  simple  and  typical  form  of  mono- 
ideic  somnambulism,  then  in  its  more  complete  forms 
of  fugues,  of  polyideic  somnambulisms,  of  artificial 
somnambulisms.  You  remember  that  we  have  always 
recognized  in  it  the  exaggerated  development  of  an  idea, 
of  a  feeling,  of  a  psychological  state,  in  a  word,  of  a 
system  of  thoughts,  which  takes  place  outside  the 
memory  and  the  normal  consciousness.  This  dis- 
sociation of  a  psychological  system  is  manifested  not  only 
by  the  preceding  development,  but  also  by  amnesia,  bear- 
ing not  only  on  the  somnambulic  period,  but  even,  in  re- 
markable cases,  on  the  whole  of  the  idea  and  of  the  feeling. 

When  later  we  studied  various  accidents  bearing  on 
the  movements  of  the  limbs,  we  recognized  that  small 
systems  of  movements,  and  sometimes  great  systems, 
rich  and  old,  constituting  real  functions,  develop 
themselves  without  control  to  an  exaggerated  degree, 


General  Definitions  319 

and  give  rise  to  tics  and  choreas  of  various  kinds. 
This  lack  of  control  is  manifested  through  negative 
phenomena  ck>sely  connected  with  the  preceding  ones, 
paralyses  and  anesthesias,  which  seem  to  play  here  the 
same  r61e  as  the  amnesias  of  somnambulism.  When 
we  came  to  the  sensorial  functions,  we  saw  the  same 
agitations  under  the  forms  of  tics,  of  pains,  and  of  hal- 
lucinations, accompanied  with  certain  losses  of  control 
which  constitute  various  anesthesias  bearing  on  the 
special  senses  as  well  as  on  the  general  sensibilities. 

In  connection  with  these  anesthesias,  we  remarked 
more  clearly  than  we  had  done  in  connection  with  the 
preceding  phenomena,  the  real  nature  of  these  amnesias, 
of  these  paralyses ;  in  a  word,  of  these  disappearances 
of  functions.  The  function  is  far  from  being  destroyed. 
It  continues  to  exist  and  often  even  develops  to  an 
exaggerated  degree.  It  is  only  suppressed  from  one 
very  special  standpoint ;  it  is  no  longer  at  the  disposal 
of  the  will  or  the  consciousness  of  the  subject.  Sur- 
prising as  it  is,  we  recognized  the  same  facts  not  only 
in  the  complex  function  of  speech,  but  even  in  the 
visceral  functions.  The  refusal  to  eat,  vomitings, 
hysterical  dyspnoeas,  are  not  diseases  of  the  stomach 
or  lungs.  They  consist  in  a  kind  of  emancipation 
of  the  cerebral  and  psychological  function  relative  to 
these  organs.  There  is  now  an  exaggeration  indepen- 
dent of  the  function ;  again  and  more  often,  a  disappear- 
ance from  consciousness  of  these  organic  wants  and  of 
the  acts  that  are  connected  with  them. 

Finally,  in  our  last  lectures,  we  sought  in  the  very 
character  of  these  patients,  in  the  status  of  their  minds, 


320      The  Major  Symptoms  of  Hysteria 

for  fundamental  stigmata  allowing  us  to  recognize  and 
understand  the  malady.  We  succeeded  in  bringing 
into  evidence,  on  the  one  hand,  stigmata  proper  to  hys- 
teria :  suggestion,  absent-mindedness  carried  to  uncon- 
sciousness, alternation,  which  we  summarized  in  the 
general  idea  of  retraction  of  the  field  of  consciousness; 
and,  on  the  other  hand,  general  stigmata,  the  absence 
of  attention,  the  lack  of  feeling  and  of  will,  which  are 
connected  with  depression,  with  the  lowering  0}  the 
mental  level. 

This  is  a  clinical  picture  that  must  suffice  us  in  prac- 
tice. If  we  remember  these  chief  facts,  by  comparing 
with  them  the  complex  and  less  clear  cases  that  practice 
presents  to  us,  we  shall  succeed  in  appreciating  the 
hysterical  disease  fairly  justly  while  avoiding  many  preju- 
dices and  errors  that  are  still  very  common  nowadays. 

Unfortunately,  the  human  mind  is  not  so  easily  con- 
tent; it  is  fond  of  dangers  and  quarrels,  and  we  feel 
the  need  of  formulating  concerning  hysterical  disease 
general  conceptions,  interpretations,  definitions,  which 
are  much  more  exposed  to  criticism  and  error.  It 
seems  to  me  that  it  is  in  some  way  a  medical  fashion  to 
give  definitions  on  hysteria.  Already,  in  the  old  book 
of  Brachet,  in  1847,  there  were,  at  the  beginning,  about 
fifty  formulas  passed  in  review.  Though  Lasegue 
said  that  hysteria  could  never  be  defined  and  that  the 
attempt  should  not  be  made,  since  that  declaration 
everybody  has  tried  to  define  it.  I  have  discussed,  in 
my  little  book  on  hysteria,  about  ten  definitions,  and 
I  have  been  foolish  enough  to  present  a  new  one.  Of 
course,  physicians  have  continued  to  define  it,  and,  since 


General  Definitions  321 

that  time,  ten  others  or  so  have  been  proposed.  We 
must  obey  the  fashion  by  saying  a  few  words  about 
these  definitions.  Let  us  try  to  derive  from  them, 
without  attaching  too  great  importance  to  the  terms, 
a  general  idea  that  suffices  us  in  practice. 

n 

I  am  wrong  in  laughing  at  the  definitions  of  hysteria 
and  observing  to  you  their  abundance,  which,  in  these 
matters,  is  not  a  proof  of  truth.  These  definitions  have 
evolved ;  they  have  made  visible  progress,  and,  though 
they  appear  numerous  nowadays,  they  come  so  close  to 
one  another  that  they  blend  together.  Do  not  forget 
that  we  are  speaking  of  medicine,  and  that  this  is  rather 
a  special  domain,  less  calm  and  serene  than  high  math- 
ematics. You  should  not  ask  too  much  of  the  virtue 
of  a  physician,  or  hope  that  he  will  confine  himself  to 
repeating  the  definition  of  a  predecessor,  even  if  he 
does  not  cite  his  name.  What  would  be  left  for  him? 
He  must  needs  change  something  in  these  definitions, 
were  it  but  a  single  word,  in  order  to  appear  to  innovate, 
which,  in  medicine,  is  indispensable.  I  do  not  exag- 
gerate in  telling  you  that,  nowadays,  three-fourths  of  the 
definitions  of  hysteria  are  nearly  identical. 

Thus,  I  shall  perhaps  surprise  you  by  telling  you  that 
there  is  no  opposition  between  the  definitions  that  glori- 
ously entitle  themselves  physiological  and  those  that 
modestly  call  themselves  psychological.  No  doubt, 
there  would  be  a  great  difference  if  these  authors  had 
seen,  really  seen,  a  lesion  characteristic  of  the  neurosis, 
y 


322      The  Major  Symptoms  of  Hysteria 

and  if  they  had  connected  the  evolution  of  the  disease 
with  this  lesion.  Never  fear,  one  can  make,  nowadays, 
a  so-called  physiological  definition  at  smaller  cost.  It  is 
enough  to  take  the  most  commonplace  psychological 
definitions  and  replace  their  terms  with  words  vaguely 
borrowed  from  the  language  of  anatomy  and  the  current 
physiological  hypotheses.  Instead  of  saying,  "  The  func- 
tion of  language  is  separated  from  the  personality," 
one  will  proudly  say,  "The  centre  of  speech  has  no 
longer  any  communication  with  the  higher  centres  of 
association."  Instead  of  saying,  "  The  mental  synthesis 
appears  to  be  diminished,"  one  will  say,  "  The  higher 
centre  of  association  is  benumbed,"  and  the  feat  will  be 
done.  I  recommend  to  you  in  this  connection  to  read 
the  last  book  of  M.  Jose  Ingenieros,  published  at 
Buenos  Ayres,  in  1906.  In  the  first  chapter,  which 
I  do  not  understand  very  well  on  account  of  my  imper- 
fect knowledge  of  Spanish,  he  shows  that  many  of 
the  definitions  of  modern  physicians  are  equivalent, 
and  I  am  quite  of  his  opinion.  So  there  is  an  ensemble 
of  points  on  which  all  the  authors  agree,  and  it  is  those 
which  we  shall  have  to  bring  into  evidence. 

Charcot  used  to  say  that  hysteria  is  an  entirely  psy- 
chic malady.  This  opinion  was  discussed  at  his  time. 
There  were  still  some  remainders  of  the  old  uterine 
and  genital  theories;  there  were  still  some  attempts 
to  connect  hysteria  with  various  nervous  lesions.  Dr. 
Bastian's  book,1  in  England,  a  very  interesting  book, 
is  very  courageous.  He  had  the  pretension  to  localize 

1  Charlton  Bastian,  "  Various  Forms  of  Hysterical  or  Functional 
Paralysis,"  1893. 


General  Definitions  323 

different  hysterical  accidents  in  different  corners  of 
the  medulla,  of  the  bulb,  or  of  the  lower  centres  of  the 
encephalon.  That  there  is  no  truth  in  those  old  con- 
ceptions, that  hysteria  will  not  be  recognized  later  as 
resulting  from  some  unknown  disturbance  of  the  se- 
cretion of  a  vascular  gland  or  from  some  lesion  of  a 
nowadays  badly  denned  nervous  system,  I  should  not 
dare  assert ;  but  one  thing  is  certain ;  namely,  that  for 
twenty  years  everybody  has  departed  from  this  view 
of  the  matter,  and  that  the  psychological  conception 
has  the  mastery.  I  again  observe  to  you  that  I  consider 
the  pretended  physiological  definitions  as  mere  trans- 
lations of  the  psychological  ideas.  This  point  is  almost 
agreed  on  by  every  one. 

But  now,  difficulties  begin.  Of  what  kind  of  psy- 
chological disturbance  is  it  a  question?  We  should 
not,  under  pretence  of  psychology,  confusedly  link 
hysteria  with  the  vague  group  of  mental  diseases  and 
the  old  nervosismus.  On  this  point,  the  work  of  a 
distinguished  physician,  Dr.  Dubois,  of  Bern,  inter- 
esting from  other  standpoints,  is,  in  my  opinion,  abso- 
lutely pernicious.  The  psychological  interpretation 
should  not  suppress  what  is  good,  what  is  excellent,  in 
our  ancestors'  works.  Now  the  last  century  produced  a 
monumental  work;  namely,  clinical  work.  With  infi- 
nite patience  and  penetration,  all  those  great  clinicians 
introduced  order  into  a  real  chaos;  they  ranged  the 
diseases  in  groups,  they  enabled  us  to  recognize  these 
groups.  Improvements  should  consist  in  consolidating 
this  edifice  and  not  in  throwing  it  down.  To  say, 
under  pretence  of  psychology,  that  a  somnambulism 


324      The  Major  Symptoms  of  Hysteria 

is  identical  with  any  delirium,  that  hysterical  vomiting 
is  a  mere  derangement  to  be  confounded  with  manias 
of  doubt  or  with  melancholias,  or  even,  perhaps,  with  the 
tics  of  idiots,  is  to  go  two  hundred  years  back,  and  it 
would  be  much  better  to  suppress  the  psychological 
interpretation  and  be  content  with  the  clinical  descrip- 
tion. Consequently,  in  making  hysteria  a  psychological 
affection,  we  do  not  intend  at  all,  as  M.  Grasset  seemed 
to  believe,  to  confound  it  with  some  sort  of  other,  or 
mental,  malady.  We  even  say  that  it  is  nowadays  the 
most  characteristic  disturbance  of  all,  and  that  it  is 
important  to  distinguish  it  well. 

The  first  psychological  notion  that  appears  to  me  to 
result  with  the  greatest  clearness  from  all  the  contem- 
porary works  is  a  notion  relative  to  the  importance  of 
ideas  in  certain  hysterical  accidents.  Charcot,  studying 
the  paralyses,  had  shown  that  the  disease  is  not  pro- 
duced by  a  real  accident,  but  by  the  idea  of  this  accident. 
It  is  not  necessary  that  the  carriage  wheel  should  really 
have  passed  over  the  patient ;  it  is  enough  if  he  has  the 
idea  that  the  wheel  passed  over  his  legs.  This  remark 
is  easy  to  generalize.  There  are  such  kinds  of  fixed 
ideas  in  somnambulisms  and  fugues ;  the  idea  of  one's 
mother's  death,  the  idea  of  visiting  tropical  countries, 
etc.  There  are  such  ideas  in  systematic  contractures, 
for  instance,  when  a  patient  seems  to  hold  her  feet 
stretched  because  she  thinks  herself  on  the  cross.  There 
are  such  ideas  in  visceral  disturbances,  and  I  have 
shown  you  the  observation  of  a  patient  who  died  of 
hunger  because  she  had  the  fixed  idea  of  the  turnips  she 
had  eaten  when  at  school.  These  remarks  have  been 


General  Definitions  325 

well  made  on  every  side.  It  has  also  been  established 
that,  with  hystericals,  ideas  have  a  greater  importance, 
and,  above  all,  a  greater  bodily  action  than  with  the 
normal  man.  They  seem  to  penetrate  more  deeply 
into  the  organism,  and  to  bring  about  motor  and  visceral 
modifications.  It  is  a  point  which  was  again  emphasized 
by  MM.  Mathieu  and  Roux,  in  a  recent  paper  they 
devoted  to  hysterical  vomiting.  "What  characterizes 
hystericals,"  they  said,  "is  less  the  fact  of  accepting 
some  idea  or  other  than  the  action  exercised  by  this 
idea  on  their  stomachs  or  intestines." 

At  the  same  time,  the  studies  on  suggestion,  which 
have  been  very  numerous,  have  allowed  clinicians 
to  realize  experimentally,  through  the  action  of  ideas, 
many  phenomena  analogous  to  hysterical  accidents. 
So  it  may  be  said  that  the  most  common  conceptions 
of  hysteria  turn  on  this  character.  Moebius  in  1888, 
after  Charcot,  said :  "We  may  consider  as  hysterical  all 
morbid  modifications  of  the  body  that  are  caused  by  rep- 
resentations."  Strumpell,  in  1892,  Bernheim,  Oppen- 
heim,and  more  recently,  Babinski,  have  repeated  each  of 
them,  of  course  with  a  slight  change  in  the  words,  quite 
similar  definitions.  "A  phenomenon  is  hysterical,"  said 
Babinski,  "when  it  can  be  produced  through  suggestion 
and  cured  through  persuasion."  Let  us  take  no  account 
of  the  end  of  the  sentence.  The  treatment  and  cure 
are  delicate  things ;  much  might  be  said  on  those  cures 
through  persuasion.  Let  us  only  retain  the  beginning : 
hysteria  is  defined  by  suggestion.  It  is  absolutely  the 
conception  of  Charcot  and  Mcebius,  hysteria  through 
fixed  ideas  and  hysteria  through  representation.  This 


v 


326      The  Major  Symptoms  of  Hysteria 

word  "suggestion,"  which,  besides,  one  takes  care  not  to 
define,  is  taken  simply  in  the  sense  attached  to  it  by  all 
the  preceding  authors,  namely  that  of  a  too-powerful 
idea  acting  on  the  body  in  an  abnormal  manner.  It  is 
easy  to  remark  here  a  unity  of  a  great  number  of  con- 
temporary conceptions. 

Ill 

I  do  not  object  very  much  to  the  preceding  definitions. 
If  more  precision  were  given  to  the  meaning  of  the  word 
"  suggestion,"  these  definitions  would  be  agreed  on  by 
everybody.  Besides,  these  definitions  bring  back  all 
the  accidents  of  the  neurosis  to  a  symptom  we  have  put 
in  the  first  rank  among  the  stigmata,  to  the  suggest- 
ibility. So  they  are  very  scientific  and  useful.  It  is 
one  of  the  first  results  of  all  the  psychological  work  that 
has  been  done-  on  hysteria.  However,  I  had  already 
discussed  them  hi  1894,  and  still  think  them  insuffi- 
cient. As  my  arguments  have  been  very  little  contra- 
dicted, I  will  try  to  formulate  them  more  clearly. 

In  the  first  place,  I  believe  that  this  conception  of 
hysteria  is  more  just  in  theory  than  in  practice.  It  rather 
summarizes  a  systematic  interpretation  than  the 
clinical  observation.  It  is  we  who  have  repeated  that 
the  accidents  seem  to  be  brought  about  by  ideas.  It  is 
not  quite  exact  that  we  always  observe  these  ideas. 
In  a  few  cases  —  and  they  are  always  the  ones  that  are 
repeated  —  the  patient,  it  is  true,  has  the  idea  that  he  is 
paralyzed.  "I  thought,"  he  says,  "that  my  leg  was 
crushed ;  I  had  the  idea  that  my  leg  no  longer  existed." 


V 
General  Definitions  327 

The  consecutive  paralysis  with  anesthesia  of  the  limb 
seems  to  be  the  exact  translation  of  his  idea.  But  it 
is  a  singular  exaggeration  to  apply  this  indifferently  to 
all  hysterical  accidents,  and  to  say  unreservedly  with 
M.  Bernheim,  "The  hysterical  realizes  his  accident 
just  as  he  conceives  it."  -> 

This  is  to  come  back  to  a  kind  of  contemptuous 
accusation  against  the  patient.  Formerly,  the  physician 
said  to  the  patient:  "You  are  paralyze^,  you  have 
crises  of  sleep  because  you  are  willing  to  have  these 
accidents."  Now,  it  is  recognized  that  he  is  not  willing 
to  have  them,  but  it  is  still  maintained  that  he  thinks 
of  them.  "You  have  such  or  such  a  crisis  with  such  or 
such  an  accident  because  you  think  of  it."  I  say  that 
this  is  not  true :  there  are  many  hystericals  who  do  not 
think  of  the  accidents  they  have.  First  of  all,  with  some 
patients,  the  accidents  develop  insidiously,  unknown  to 
them.  They  become  anesthetic,  paralytic,  anorexic, 
amaurotic,  without  in  the  least  suspecting  it.  Clinical 
practice  shows  you  this  every  day.  What  shall  we  do, 
then,  with  the  observations  already  cited  by  Lasegue, 
in  which  it  is  the  physician  who  reveals  to  the  subject 
an  anesthesia,  or  the  blindness  of  one  eye,  which  he 
was  not  aware  of.  In  other  cases,  it  is  incontestable 
that  the  accident  develops  with  details,  with  an  evolution 
that  the  patient  does  not  know.  Whatever  M.  Bern- 
heim may  say  about  it,  I  do  not  admit  at  all  that  hysteri- 
cals have,  at  will,  paralyses,  with  or  without  anesthesias. 
I  do  not  admit  that  these  patients  know  what  happens 
in  their  somnambulisms,  that  they  combine  the  disease 
beforehand. 


328      The  Major  Symptoms  of  Hysteria 

If  these  patients  have  fixed  ideas  —  and  I  acknowl- 
edge that  this  is  very  frequent  —  it  should  be  well 
remarked  that  these  fixed  ideas  have  no  relation  to  the 
medical  form  of  their  accident.  One  has  the  fixed  idea 
of  her  mother's  death ;  it  is  not  at  all  the  fixed  idea  of 
somnambulism  and  of  its  laws.  Another  has  a  fixed 
idea  relative  to  the  flight  of  his  wife,  who  robbed  him ; 
it  is  not  the  fixed  idea  of  dumbness.  Much  oftener 
than  is  believed,  the  accident  develops  independently 
of  the  ideas  of  the  subject,  whether  the  subject  does  not 
think  of  it  or  thinks  of  something  else. 

I  should  like  to  present,  in  the  second  place,  an  argu- 
ment which  is  still  weak,  but  the  importance  of  which 
will  grow  more  and  more.  It  relates  to  the  physio- 
logical and  psychological  laws  of  hysterical  accidents, 
laws  of  which  we  are  ignorant,  and  of  which  the  subjects 
are  ignorant  like  us.  When  we  see  a  crowd  of  acci- 
dents evolve  according  to  these  laws,  which  we  painfully 
describe,  we  cannot  say  that  they  are  due  to  auto- 
suggestion. 

I  remind  you  of  the  laws  of  somnambulisms,  which, 
in  my  opinion,  are  capital.  Somnambulism  is  followed 
by  an  amnesia  which  bears  not  only  on  the  abnormal 
period,  but  often  also  on  the  idea  itself  that  fills  it  and 
on  all  the  feelings  connected  with  it.  This  amnesia 
disappears  and  all  the  apparently  lost  remembrances 
are  restored  when  the  subject  comes  back  into  the 
same  somnambulism.  In  the  case  of  Irene,  which  I 
take  as  a  type,  there  is  in  the  waking  state  an  amnesia 
not  only  of  the  crisis,  but  also  of  her  mother's  death, 
of  the  three  preceding  months,  and  of  all  that  is  con- 


General  Definitions  329 

nected  with  her  affection  for  her  mother,  and  during 
the  fits  all  these  remembrances  are  perfect.  Do  the 
subjects  who  show  us  applications  of  these  laws  ; —  and, 
in  my  opinion,  they  are  very  numerous  —  do  these  sub- 
jects know  them  ?  Have  they  the  idea  of  having  such 
an  oblivion  in  connection  with  their  somnambulism? 
How  very  unlikely  !  They  would  much  rather  have  the 
contrary  idea,  that  of  being  obsessed  by  their  remem- 
brance like  the  psychasthenics. 

The  more  hysterical  paralyses  are  studied,  the  more 
laws  of  a  similar  kind  will  be  discovered.  I  have 
observed  to  you  that  the  accidents  bear  on  functions. 
It  is  true  that  these  functions  oftenest  appear  to  be  iden- 
tical with  those  which  the  vulgar  have  themselves  recog- 
nized, the  function  of  alimentation,  the  function  of 
walk,  the  function  of  the  movements  of  the  hand.  In 
this  case,  you  will  tell  me,  the  paralysis  might  very  well 
be  brought  about  by  an  idea,  since  the  popular  idea 
coincides  with  the  very  limits  of  the  paralysis.  This  is 
true  in  general,  simply  because  the  popular  ideas  are 
true.  The  great  divisions  of  the  functions  correspond 
to  the  great  divisions  of  the  organs,  and  the  popular 
analysis  has  been  correct,  that  is  all.  But  there  are 
some  cases  in  which  the  popular  analysis  proves  igno- 
rant and  in  which  hysterical  paralysis  analyzes  the  func- 
tions much  better  than  good  sense  does.  Why  are  the , 
disturbances  of  speech  accompanied  with  right-sided 
hemiplegy?  Why  are  there  cases  of  hemianopsia? 
How  is  it  that  there  are  distinct  paralyses  of  monocular 
vision  and  of  binocular  vision?  Why  are  there  dis- 
turbances of  accommodation?  If  you  pass  on  to  con- 


330      The  Major  Symptoms  of  Hysteria 

tractures,  do  you  really  believe  that  the  patient  has  the 
idea  of  rigidity  without  fatigue,  without  increase  of  the 
temperature  ?  That  he  has  the  idea  of  that  modification 
of  the  reactions,  of  that  slowness  of  the  muscular  shake  ? 
I  am  convinced,  for  my  part,  that  hysterical  contracture 
has  its  own  laws,  quite  peculiar  to  it,  presenting  us, 
as  I  told  you,  a  degradation  of  the  contraction  of  the 
striated  muscles.  All  this  is  outside  of  the  thought 
of  the  subject.  As  I  told  you  at  the  beginning,  it  will 
be,  later,  a  matter  of  astonishment  that  physicians  should 
have  attributed  to  the  caprice  of  the  subject  all  the 
psychological  and  physiological  laws  that  will  be  dis- 
covered in  these  various  accidents. 

Lastly,  I  insist  on  a  third  argument.  These  defini- 
tions have  a  meaning  only  on  condition  that  the  words 
"fixed  idea"  and  "suggestion"  are  used  in  a  particular 
sense.  This  sense  should  be  that,  with  hystericals, 
ideas  do  not  conduct  themselves  as  with  everybody. 
It  is  of  no  use  for  me  to  represent  to  myself  that  I  am 
asleep;  I  do  not,  therefore,  sleep.  All  these  authors 
imply  tacitly  that  these  ideas  act  in  a  special  manner  on 
the  mind  and  organism.  I  answer  that  it  is  this  special 
action  that  is  the  essential  point ;  it  is  this  action  that 
constitutes  hysteria,  and  you  have  not  the  right  to  make 
a  definition  in  which  you  tacitly  imply  what  is  essential. 
Begin  by  defining  what  you  call  suggestion,  and  after- 
wards you  may  say,  if  you  choose  and  if  it  is  true,  that 
hysteria  is  a  disease  due  to  suggestion.  But,  to  define 
suggestion,  you  will  be  obliged  to  introduce  into  your 
definition  certain  new  notions  which  are  precisely  those 
I  asked  for. 


General  Definitions  331 

; 
IV 

You  will  be  obliged  to  recognize  that  these  ideas 
present  themselves  in  special  conditions,  that  they 
develop  out  of  measure  because  they  meet  with  no  coun- 
terpoise in  the  mind,  because  they  are  isolated,  owing  to 
a  strange  absent-mindedness  of  the  subject ;  in  a  word, 
you  will  recognize  the  other  stigmata,  absent-minded- 
ness and  the  retraction  of  the  field  of  consciousness. 
When  you  have  once  admitted  this  retraction  of  the  field 
of  consciousness  as  one  of  the  conditions  of  suggestion 
itself,  why  should  you  maintain  that  it  can  produce  noth- 
ing but  suggestions?  Why  should  you  not  admit  that 
this  disease  of  the  mind  may  be  manifested  by  some- 
thing else?  If  this  retraction  has  given  too  much 
power  to  certain  ideas,  does  it  not  produce,  on  the  other 
hand,  some  blanks  ?  Can  it  not  isolate  and  emancipate 
one  function  and  suppress  another  from  consciousness  ? 

We  then  arrive  at  another  group  of  definitions  in 
which  I  range  mine.  They  are  definitions,  in  my 
opinion,  more  profound,  into  which  enter  the  phenomena 
of  dissociation  of  consciousness,  such  as  is  observed  in 
all  hysterical  disturbances.  Suggestion  itself  is  but  a 
case  of  this  dissociation  of  consciousness.  There  are 
many  others  beside  the  one  in  somnambulisms,  in  au- 
tomatic words,  in  emotional  attacks,  in  all  the  functional 
paralyses.  Many  authors,  Gurney,  Myers,  Laurent, 
Breuer  and  Freud,  Benedict,  Oppenheim,  Jolly,  Pick, 
Morton  Prince,  have  thought  like  me  that  a  place  should 
be  made  for  the  disposition  to  somnambulism.  Was 
not  the  somnambulic  attack  for  us  the  type  of  hysterical 


332      The  Major  Symptoms  of  Hysteria 

accidents  in  1889?  "The  disposition  to  this  dissocia- 
tion and,  at  the  same  time,  the  formation  of  states  of 
consciousness,  which  we  propose  to  collect  under  the 
name  of  hypnoid  states,  constitute  the  fundamental 
phenomenon  of  this  neurosis,"  said  MM.  Breuer  and 
Freud,  of  Vienna,  in  1893. 

The  point  which  seems  to  me  to  be  the  most  delicate 
in  this  definition  is  to  indicate  to  what  depth  this  dis- 
sociation reaches.  In  reality  we  might  say  that  demen- 
tias themselves  are  dissociations  of  thought  and  of  the 
motor  functions.  We  must  remember  that,  in  hysteria, 
the  functions  do  not  dissolve  entirely,  that  they  continue 
to  subsist  emancipated  with  their  systematization. 
What  is  dissolved  is  personality,  the  system  of  grouping 
of  the  different  functions  around  the  same  personality. 
I  maintain  to  this  day  that,  if  hysteria  is  a  mental 
malady,  it  is  not  a  mental  malady  like  any  other, 
impairing  the  social  sentiments  or  destroying  the  con- 
stitution of  ideas.  It  is  a  malady  of  the  personal  syn- 
thesis, and  I  will  take  up  again,  very  slightly  modified, 
the  formula  I  have  already  presented.  Hysteria  is  a 
form  of  mental  depression  characterized  by  the  retraction 
of  the  field  of  personal  consciousness  and  a  tendency  to 
the  dissociation  and  emancipation  of  the  systems  of  ideas 
and  functions  that  constitute  personality. 


Let  us  leave  too  general  discussions  and  come  back 
to  a  more  clinical  conception  of  things.  The  most 
important  problem  is  not  for  me  to  understand  what 


General  Definitions  333 

hysteria  in  general  is,  but  to  account  for  the  practical 
evolution  of  the  accidents  with  such  or  such  a  person. 
The  difficulty  we  meet  with,  then,  is  a  difficulty  of  local- 
ization. How  is  it  that  with  one  person  the  hysteria 
bears  on  the  arm,  with  another  on  the  stomach,  and  that, 
with  a  third,  it  only  reaches  a  system  of  ideas,  which  it 
turns  into  a  somnambulism  ?  It  is  on  this  search  for  an 
interpretation  proper  to  each  subject  that  one  should 
dwell,  to  my  mind,  much  more  than  on  general  quarrels 
of  definition. 

The  starting-point  of  hysteria  is  the  same  as  that  of 
most  great  neuroses,  it  is  a  depression,  an  exhaustion  of  the 
higher  functions  of  the  encephalon.  All  the  psychological 
operations  do  not  present,  as  I  repeat,  the  same  difficulty. 
There  are  some  operations  that  are  easy  for  all  kinds  of 
reasons,  first,  because  they  are  simple  and  only  require 
the  union  of  a  small  number  of  elements;  second, 
because  they  are  old,  because  their  systematization 
was  the  work  of  our  ancestors  and  is  inscribed  in  strongly 
constituted  organs.  There  are  some  other  functions 
that  are  difficult  because,  on  the  one  hand,  they  are 
very  complex,  because  they  necessitate  the  systematiza- 
tion of  an  infinite  number  of  elements,  and  because, 
on  the  other  hand,  they  are  very  new  and  require  a 
present  synthesis,  not  yet  inscribed  in  the  organism. 
Now,  our  nervous  strength,  which  we  do  not  know  at  all, 
presents  oscillations.  When  it  is  high,  we  easily  accom- 
plish the  operations  of  the  second  group,  we  have  an 
extended  consciousness,  we  turn  back  from  no  new 
study  or  action. 

But  there  are  many  circumstances  in  which  this 


334      The  Major  Symptoms  of  Hysteria 

nervous  tension  is  lowered,  especially  with  those  hered- 
itarily predisposed.  There  are  some  physiological 
periods,  puberty  for  instance,  at  which  the  vital  forces 
seem  to  be  busy  elsewhere  and  to  leave  no  great  re- 
source to  the  brain.  There  are  diseases  that,  through  a 
thousand  mechanisms,  through  local  lesions,  through 
intoxication,  through  microbian  infection,  lower  our 
nervous  tension.  Even  in  normal  functioning,  physical 
or  intellectual  fatigue  is  enough  to  produce  momentarily 
the  same  result.  Lastly,  —  the  fact  is  more  difficult 
to  understand  but  incontestable,  —  emotion  is  character- 
ized by  this  lowering  of  the  nervous  strength.  Very 
likely,  in  emotion,  there  is  a  great  expense  of  nervous 
strength  necessitated  by  the  new  problem  suddenly 
set,  and  the  emotional  disturbance  must  come  close 
to  that  of  fatigue.  However  it  may  be,  our  patients 
have  been  exhausted  through  one  of  the  preceding 
causes.  If  hereditarily  predisposed,  they  are  enfeebled 
by  puberty,  or  they  succumb  to  intoxication,  fatigue, 
or  emotion.  The  diminution,  the  lowering  of  the  ner- 
vous tension,  may  bring  about  a  general  lowering  of 
all  the  functions,  and  especially  of  the  highest.  This 
is  what  takes  place  in  the  psychasthenic  neuroses,  in 
which  the  localization  on  a  special  point  exists  in  a 
rather  slight  degree. 

With  hystericals,  in  consequence  of  particular  dis- 
positions, the  lowering  of  the  nervous  strength  produces, 
in  some  manner,  a  superficial  retraction;  there  is, 
as  it  were,  an  autotomy.  Consciousness,  which  is  no 
longer  able  to  perform  too  complex  operations,  gives 
up  some  of  them.  There  is,  it  is  true,  a  general  en- 


General  Definitions  335 

feeblement,  which  manifests  itself  through  the  common 
stigmata,  but  there  is,  above  all,  a  localization  of  the 
mental  insufficiency  on  such  or  such  particular  function. 
So  we  find  again  in  hysteria  the  problem  of  localization, 
which  is  of  great  importance  in  this  disease. 

No  doubt,  in  a  certain  number  of  cases,  the  local- 
ization is  effected  through  suggestion.  An  idea  sug- 
gested from  without  attracts  the  thinking  in  one  di- 
rection or  another,  and  brings  about,  besides,  according 
to  laws  the  subject  does  not  know,  such  or  such  auto- 
matic functioning  and  such  or  such  a  loss  of  function. 

This  is  only  a  particular  case.  The  localization  may 
also  be  effected  through  a  process  akin  to  suggestion, 
but  which  is  not  identical  with  it,  according  to  the  laws 
of  psychological  automatism.  I  have  often  drawn  your 
attention  to  those  individuals,  who,  having  had  an  acci- 
dent in  certain  circumstances  and  having  been  cured, 
always  recommence  the  same  accident  each  time  they 
experience  an  emotion,  though  it  has  no  relation  with 
the  first.  The  man  who  was  wounded  by  a  railroad 
engine  has  a  delirium  hi  which  he  sees  an  engine  coming 
towards  him.  This  is  quite  simple.  Eleven  years 
afterwards,  he  sees  his  wife  die,  and  he  recommences 
the  engine  delirium.  Another  has  the  tic  of  blowing 
through  one  of  his  nostrils  because  he  had  a  scab  in 
his  nose,  in  consequence  of  a  bleeding  at  the  nose.  He 
recovers  from  his  tic,  but  he  recommences  it  now,  be- 
cause he  loses  his  fortune,  because  his  child  is  ill,  etc. 

Third  law:  The  dissociation  simply  bears  on  a 
function  that,  for  some  reason  or  other,  has  remained 
weak  and  disturbed.  Many  of  our  patients  become 


336      The  Major  Symptoms  of  Hysteria 

dumb  after  an  emotion,  but  they  were  formerly  in- 
clined to  stammer,  their  speech  was  quite  insufficient. 
A  girl's  right  leg  becomes  paralyzed ;  the  reason  is  that, 
in  her  childhood,  her  right  leg  was  affected  with  rachitis. 
In  the  case  of  another  girl,  the  paralysis  of  a  leg  is  due 
to  the  fact  that,  in  her  childhood,  the  leg  was  affected 
with  a  white  tumour  and  remained  long  in  bandage. 
This  remark  relates  specially  to  the  very  numerous 
cases  of  associated  hysteria:  a  disease  of  any  kind 
bearing  on  viscera,  often  an  organic  lesion  of  the 
medulla  or  of  the  brain,  enfeebles  or  disturbs  some 
function  and  it  is  on  this  function  that  the  hysteric 
emancipation  is  localized.  So,  in  certain  cases,  hysteria 
makes  conspicuous  some  light  symptoms  of  organic 
diseases  of  the  nervous  system  quite  at  their  beginning 
by  exaggerating  them  beyond  all  measure.  The  fact, 
for  instance,  was  frequently  observed  in  the  cases  of 
tabetic  vomiting  associated  with  hysteric  vomiting. 

Fourth  law :  The  function  that  disappears  is  the  most 
complicated  and  the  most  difficult  for  the  subject. 
This  law  applies  chiefly  to  professional  and  social 
paralyses. 

Finally,  fifth  law:  We  remark  a  very  curious  fact, 
which  we  recognize  without  always  being  able  to  account 
for  it.  The  dissociation  bears  on  the  function  that  was 
in  full  activity  at  the  moment  of  a  great  emotion. 
There  are  here  some  physiological  laws  that  cause  the 
chief  disturbance  to  bear  on  this  function,  that  make 
it,  probably  through  an  association  of  ideas,  through  an 
evocation  of  the  emotion,  the  most  difficult  for  the 
subject. 


General  Definitions  337 

It  is  the  study  of  these  laws,  it  is  the  search  for  these 
conditions,  that  constitute  the  important  part  of  the 
study  of  hysteria.  Leave  the  discussions  of  general 
definitions;  they  are  premature  discussions,  which 
bear  on  purely  verbal  differences.  Retain  from  these 
lessons  the  importance  that  attaches  to  the  study  of  the 
psychological  functions,  the  necessity  of  analyzing,  in 
each  particular  case,  the  mental  state  of  the  patient. 

If  these  lectures  have  inspired  you  with  some  interest 
for  this  kind  of  studies,  if  they  can  contribute  to  develop 
in  your  beautiful  country  the  researches  of  pathological 
psychology,  beside  the  researches  of  experimental 
psychology,  so  brilliantly  represented,  I  think  you  will 
not  have  lost  too  much  time  in  trying  to  understand  a 
barbarous  language. 

For  my  part,  I  deeply  feel  your  kind  attention  and 
reception,  and  I  am  proud  of  having  had,  for  a  few  days, 
the  honour  of  teaching  you  and  of  being  the  colleague  of 
the  masters  of  Harvard  University. 


INDEX 


Abdomen,  swelling  of,  among  phe- 
nomena of  respiration,  263-264. 

Absent-mindedness,  172,  296,  309- 
311;  rhythm  of  Cheyne-Stokes 
and,  254. 

Abulia,  315. 

Accommodation,  spasm  of,  206-207, 

329- 

Aerophagia,  phenomenon  of,  260. 

Alimentation,  hysterical  disturbances 
of,  227  ff.;  tics  of,  264-269. 

Allochiria,  183. 

Alternation,  stigma  of,  302. 

Amaurosis,  unilateral,  168-169,  171, 
188-195,  302. 

Amnesia,  retrograde,  37-43,  72;  con- 
tinuous, 72,  314;  analysis  of  con- 
tinuous, 72-74;  the  stigma  of 
somnambulism,  124-125. 

Amnesias,  graphic  method  for  repre- 
sentation of,  70-77. 

Anesthesia,  hysteric,  in  motor  dis- 
turbances, 124-126;  description  of 
hysteric,  150-158;  in  paralyses, 
150-158;  difference  between  hys- 
teric and  organic,  162-163;  change 
in,  during  intoxication  of  subjects 
of,  165;  carried  to  high  degree  in 
unilateral  amaurosis,  189;  theory 
of  anorexy  through  anesthesia  of 
stomach,  236-238 ;  respiratory,  246- 
247;  stigma  of,  272-276. 

Anesthesias,  mobility  of,   163-164. 

Anorexy,  hysterical,  228-233;  three 
periods  of,  230;  theories  of,  233- 
234;  motor  agitations  in,  239-241; 
suppression  of  feeling  of  fatigue  in, 
241-242;  paralyses  resulting  from, 

243-244- 

Anosmia,  hysterical,  249. 
Apepsia  hysterica,  Gull's,  228. 


Aphasia,    209;     distinction    between 

hysterical  dumbness  and,  215-217; 

motor,  218-219. 
Aphonia,  317. 

Asphyxia,  hysterical,  247-248. 
Aspiration,  tics  of,  266. 
Astasia-abasia,  177-181,  217. 
Astruc,  14. 

Attention,  incapacity  of,  314. 
Automatism,  ambulatory,  44-45   (see 

Fugues);    of  writing,  212;    verbal, 

225. 
Azam,  Dr.,  case  of  double  personality 

reported  by,  78-82. 


B 


Babinski,  on  reflexes,  147,  148,  150; 

mentioned,  178,  279;    definition  of 

hysteria  by,  325. 
Ballet,  205,  219,  277. 
Barks,  hysterical,  262. 
Bastian,   Charlton,  quoted,   175-176; 

work  by,  322. 
Bawl,  the  hysterical,  272. 
Beauchamp,  Miss,  a  case  of  complex 

personality,  85. 
Benedict,  331. 

Bernheim,  4,  17,  192,  193,  327;  defi- 
nition of  hysteria  by,  325. 
Binet,  4. 

Bladder,  troubles  of  function  of,  244. 
Blindness,  hysterical,  185  ff.;  cases  of, 

186-187. 

Bloch,  apparatus  devised  by,  350. 
Blocq,    form   of  '  hysterical   paralysis 

pointed  out  by,  177. 
Blood,  vomiting  of,  268-269. 
Borel,  186. 
Bourru,  83. 
Brachet,  15,  320. 
Breuer,  4,  331,  332. 
Brewster,  experiment  of,  192-193. 


339 


340 


Index 


Briquet,  16,  151,  156,  167,  210,  255; 
quoted  on  hysteric  fits,  102. 

Brissaud,  4. 

Bristow,  205. 

Broca,  215. 

Brodie,  English  physician,  15-16, 
140,  176;  work  of,  on  local  ner- 
vous affections,  131. 

Bulimia,  264-265. 

Burcq,  167,  236,  300;  quoted  on 
anesthesia  and  muscular  weakness, 

183- 
Burot,  83. 

C 

Cartaz,  on  hysterical  dumbness,  210, 
214. 

Catalepsy,  form  of  somnambulism 
called,  33. 

Chairou,  249. 

Charcot,  T.  M.,  3,  4,  12,  16-17,  20-21, 
I31.  140,  144,  IS1.  I53.  161-162, 
177,  198,  210,  233;  quoted  regard- 
ing fugues,  60 ;  cases  of  double  per- 
sonalities of,  74 ;  on  motor  agitations, 
121,122;  helicopode  and  helcopode 
gaits  of,  146,  174;  case  of  hysteri- 
cal dumbness  studied  by,  211;  the 
anesthesia  of,  273-276;  definition 
of  hysteria  by,  324,  325. 

Cheeks,  spasms  of,  265. 

Cheyne-Stokes,   rhythm  of,   252-254. 

Chorea  of  Sydenham,  123. 

Choreas,  rhythmical,  121-123. 

Clonus  of  foot,  147;  sign  of,  149-150. 

Consciousness,  the  field  of,  303-304; 
contraction  of  field  of,  304-311,  316, 
332;  dissociation  of,  331-332. 

Contraction  of  voluntary  movements, 
295-296. 

Contractures,  hysteric,  131  ff.;  errors 
resulting  from,  in  diagnoses,  132- 
133;  causes  and  cure  of,  133-135; 
miraculous  cures  and,  134;  author's' 
hypothesis  concerning,  136-137; 
phenomenon  of  anesthesia  in,  273- 
274. 

Convulsive  attacks,  94-104;  analogy 
between  somnambulisms  and,  95- 
96;  false  theories  concerning,  98- 


99;  difference  between  epileptic 
fits  and,  100,  no;  distinguishing 
characteristics  of,  100-104. 

Coprolalia,  225. 

Coriat,  H.,  paper  by,  55. 

Corson,  Mrs.  C.  Rollin,  303. 

Coste,  works  of,  249. 

Cough,  the  hysterical,  260-261. 

Coulson,  131. 

Courtney,  Dr.  J.  M.,  paper  by,  cited, 
58-59- 

D 

Dana,  Dr.,  cited,  66. 

Danilewsky,  works  of,  249. 

Deafness,  hysterical,  183-184. 

Dejerine,  observations  of  functional 
hemianopsia  by,  200. 

Delbceuf,  4. 

Despine,  Dr.  (d'Aix),  139-140,  236. 

Devil's  claws,  151,  272-273. 

Diaphragm,  paralysis  of,  254-257. 

Digestion,  hysterical  disturbances  of, 
227  ff. 

Diplopy,  monocular,  207. 

Dipsomania,  polydipsia  distinguished 
from,  265. 

"Diseases  of  Memory,"  Ribot's,  78. 

Dissociation  of  consciousness,  331-332. 

"Dissociation  of  a  Personality," 
Prince's,  67. 

Double  personalities,  66  ff.;  rarity  of 
cases  of,  67;  the  first  type  of,  the 
Lady  of  MacNish,  68-69;  an^ 
reciprocal  somnambulisms,  72-77; 
the  dominating  somnambulism  in, 
77  ff.;  case  of  Felida  X.,  78-81; 
the  group  of  complex  cases,  83-86; 
case  of  Marceline,  an  artificial 
double  personality,  86-91;  os- 
cillation of  mental  activity  in,  92. 

Drinking,  mania  for,  265. 

Dubois,  Dr.,  323. 

Duchenne  (de  Boulogne),  15,  140. 

Duchesne,  Marguerite  Franooise,  case 
of,  210. 

Dumbness,  hysterical,  209-215. 

Dumontpallier,  282,  300. 

Dutil,  165. 

Dyschromatopsia,  204. 


Index 


34i 


Eating,  mania  for,  264-265. 

Echolalia,  225. 

Electricity,   action  of,  on  sensibility, 

167;   power  of  speech  restored  by, 

210. 

Emotional  disturbances,  314. 
Equivalences,  298,  301-302. 
Eructation,  tics  of,  266. 
Eyes,  disturbances  in  motion  of  the, 

205-207.    See  Vision. 


Falsehood  in  hysteria,  278-279. 

Fancher,  "  Mollie,"  double  personal- 
ities of,  84-85. 

Felida  X.,  story  of  double  personal- 
ity of,  78-81. 

Fere,  Dr.,  4,  6;  observations  of,  on 
hysterical  paralyses,  141-142;  quoted 
on  hysterical  paralyses,  175. 

Fits,  hysteric,  94  ff.;  false  theories 
about,  98-99;  difference  between 
epileptic  and,  100,  no;  character- 
istics of,  100-104. 

Fixed  idea,  theory  of,  in  anorexics, 
234-235;  importance  of,  in  certain 
hysterical  accidents,  324-325;  have 
no  relation  to  the  medical  form  of 
the  accident,  328. 

Flees,  Dr.,  box  of,  for  eye-testing, 
190-192. 

Flights.    See  Fugues. 

Flourens,  249. 

Forel,  4. 

Francais,  Henry,  239. 

Franck,  works  of,  249. 

Freud,  Professor,  4,  145,  331,  332. 

Fugues,  hysterical,  44-45;  examples 
of,  45-61;  analogy  between  mo- 
noideic  somnambulisms  and,  54-59 ; 
differences  between  somnambu- 
lisms and,  59-61;  artificial  repro- 
duction of,  112. 


Gelle,  220. 
Georget,  15,  151. 


Goodhart,  "Multiple  Personality"  by, 

67. 

Grasset,  4,  324. 
Gull,    W.,    anorexy    described    by, 

228. 
Gurney,  331. 


H 


Hallion,  study  of  vascular  reflexes  by, 
160. 

Hallucinations,  connected  with  som- 
nambulisms, 32-37,  59-60;  lack- 
ing in  fugues,  60. 

Harris,  Wilfred,  on  hysterical  hemi- 
anopsia,  200-201. 

Hauron,  Ducos  de,  194. 

Helicopode  and  helcopode  gaits,  146, 
174. 

Hemianesthesia,  153-154. 

Hemianopsia,  hysterical,  199,  329; 
compared  with  hysterical  hemiplegy, 
200-20 i. 

Hemiplefjy,  142-143;  organic  and 
hysteric,  146-147;  hysterical  hemia- 
nopsia  compared  with,  200-201; 
a  case  of  hysterical,  212. 

Hiccough,  the  hysterical,  259-260. 

Huchard,  176. 

Huf  eland,  15. 

Hypnogenic  points,  108-109,  "3- 

Hypnotism,  case  of  double  personality 
treated  by  means  of,  86-89;  arti- 
ficial somnambulisms  called,  114; 
question  concerning  hysteric  som- 
nambulism and,  114-116. 

Hysteria,  evolution  of  studies  about, 
13  ff.;  derivation  of  the  word,  15; 
notice  of  Charcot's  work  in,  16-17; 
the  psychological  type  of,  18-20; 
somnambulism  the  typical  form  of 
accidents  of,  22-24;  study  of  the 
stigmata  of,  270  ff.;  suggestibility 
the  most  important  stigma  of,  285- 
292;  other  stigmata  of,  293  ff.; 
r6sum6  of  typical  symptoms  of,  317- 
321;  various  definitions  of,  321- 
326;  discussion  of  definitions,  326- 
332;  author's  formula  of,  332. 

Hysterogenic  points,  98-99,  113. 


342 


Index 


Idea.     See  Fixed  idea. 

Inanition,  hysterical,  228-229;  pe- 
riod of,  in  hysterical  anorexy,  232. 

Incapacity,  of  attention,  314;  of 
beginning  and  stopping,  315. 

Incompleteness,  the  feelings  of,  312- 

3*3- 

Ingenieros,  Jose,  book  by,  322. 

Insensibility,  phenomena  of,  in  tics, 
124-125;  examination  of,  in 
paralyses,  150-158;  vanishing  of, 
during  intoxication,  165. 

Insomnia,  315. 

Inspiration  tics,  259. 

"Intelligence,"    Taine's,    78. 

Intestine,  paralysis  of,  in  disturb- 
ances of  alimentation,  243-244. 

Intoxication  and  anesthesia,  165. 


Jaccoud,  form  of  hysterical  paralysis 

pointed  out  by,  177. 
James,  William,   cited,   175. 
Janet,  Jules,  162,  165. 
Jaws,  spasms  of,  265. 
Jolly,  F.,  188,  331. 


Kaempfen,  case  of  retrograde  am- 
nesia of,  71. 

Kissel,  case  of  anorexy  cited  by,  229. 

Koenig,  case  of  ophthalmoplegy 
of,  205. 

Kussmaul,  210. 

Kuttner,  patient  of,  with  vomiting 
of  blood,  268. 


"Lady  of  MacNish,"  story  of,  68- 
69;  analysis  of  case,  72-77;  a 
type  of  so-called  "reciprocal 
somnambulism,"  74. 

Landolt,  186. 

Landouzy,  15,  151. 

Lapses  of  the  mental  functions, 
313-316. 


Lasegue,  131,  161,  168,  171-172, 
233,  320,  327;  anorexy  described 
by,  228. 

Laughter,  hysterical,  261. 

Laurent,  331. 

Laziness,  hysterical  state  of,  314. 

Lebreton,  205. 

"Lecons  du  Mardi,"  Charcot's, 
219. 

Lepine,  219,  249. 

Lepois,  Charles,  14,  185-186. 

Lermoyez,  M.,  246—847. 

Limbs,  disturbances  in  motor  func- 
tions of,  117-119. 

Localization,  the  laws  of,  333-337. 

Lowering  of  the  mental  level,  the, 
316. 

M 

Mabille,  case  of  Louis  Vivet  pub- 
lished by,  83. 

MacNish,  Dr.,  67,  68. 

Macropsia,  207. 

Malebranche,  291. 

Marceline,  the  case  of,  87-91. 

Marie,  Dr.  Pierre,  4,  209. 

Marion,  Elie,  case  of,  225. 

Mathieu,  A.,  267,  268,  325. 

Memory,  loss  of,  connected  with 
somnambulism,  3  7-43 ;  absence  of, 
3*4- 

"Mental  State  of  Hystericals," 
Janet's,  303. 

Merycism,  266. 

Mesnet,  4. 

Meteorism  of  the  abdomen,  263- 
264. 

Micro psia,  207. 

Miracles,  performance  of  religious, 
accounted  for,  134. 

"Miracles  of  Deacon  Paris,"  Mont- 
geron's,  134,  210. 

Mitchell,  S.  Weir,  67;  case  of 
double  personality  of,  74-77. 

Mcebius,  4,  277;  definition  of  hys- 
teria by,  325. 

Monoplegy,  144. 

Montgeron,  Carre  de,  134,  210. 

Morax,  206. 

Mosso,  249,  254. 


Index 


343 


Motor  disturbances  of  limbs,   117- 

119. 
"Multiple   Personality,"    Sidis   and 

Goodhart's,  67. 
Mil  nster berg,  Professor,  3. 
Mutism,  hysterical,  209-215. 
Myers,  Arthur,  84,  331. 


N 
Narrowing  of  the  visual  field,  195- 

2OI. 

Neuroses,  traumatic,  study  of,  140. 


(Esophagus,  spasms  of  the,  243- 
244,  266. 

Ophthalmoplegy,  205-206. 

Oppenheim,  140,  224,  331;  defini- 
tion of  hysteria  by,  325. 


Pachon,  works  of,  249. 

Page,  W.,  176. 

Paget,  131. 

Paralyses,  hysteric,  138-139;  causes 
of,  140-142;  varieties  of  (hemi- 
plegy,  paraplegy,  monoplegy, 
paralyses  of  the  trunk),  142-144; 
diagnosis  of,  145-150;  difference 
between  organic  paralyses  and, 
146;  systematic,  178;  of  diges- 
tive organs  in  disturbances  of 
alimentation,  243-244 ;  respira- 
tory, 246  ff. ;  of  the  diaphragm, 
254-257;  phenomenon  of 
anesthesia  in,  273-274. 

Paraplegy,  143. 

Pare',  Ambroise,  14. 

Parinaud,  186,  192,  193,  206,  207. 

Pawlof,  237. 

Personalities,  double.  See  Double 
personalities. 

Pharynx,  spasms  of  the,  265. 

"Philosophy  of  Sleep,"  MacNish's, 
68. 

Photophobia,  205. 

Pick,  A.,  295-296,  331. 


Pitres,  4. 

Polydipsia,  265. 

Polyopy,  207. 

Polypnoea,  respiration  in  cases  of, 
2SS-256.  257-258. 

Polyuria,  265. 

Pomme,  14. 

Prince,  Morton,  4,  331;  cited  con- 
cerning double  personalities,  67; 
observations  of  Miss  Beauchamp, 

85- 
Ptyalism,  266. 


Railway  spine,  140. 

Ramadier,  83. 

Recruits,  eye  tests  for,  189-192. 

Reflexes,  147;  cutaneous,  148; 
signs  of,  149;  pupillary,  150,  189; 
absence  of  modification  of,  160- 
162. 

Regnard,  192. 

Regurgitation,  266. 

Reproduction  of  hysteric  accidents, 
110-115. 

Respiration,  tics  of,  245  ff. ;  paral- 
ysis of,  246  ff. ;  alternating  see- 
saw, 255. 

Retraction  of  field  of  consciousness, 
304-311,  316,  332. 

Revery,  hysterical  state  of,  314. 

Revillod,  210. 

Reynolds,  Mary,  case  of  double  per- 
sonality, 74-77. 

Reynolds,  Russell,  140. 

Rhythm  of  Cheyne-Stokes,  252- 
254. 

Ribot,  Professor,  3,  4;  on  double 
personality,  78. 

Richer,  Paul,  4,  131. 

Richet,  Charles,  4,  249,  277. 

Robertson,  Argyll,  150. 

Roux,  J.  C.,  267,  268,  335. 


Salivation,  tics  of,  265. 

Salute,  the,  in  motor  agitations,  121. 

Saulle,  Legrand  du,  15,  83,  277,  279. 


Index 


Sauvage,  14. 

Seglas,  177,  225. 

Sensibility,  disturbances  of,  249-251. 

Sensitiveness,  modifications  of,  dur- 
ing induced  somnambulisms,  166- 
167. 

Sidis,  B.,  "Multiple  Personality" 
by,  67. 

Sigh,  the  hysterical,  259. 

Simulation,  perpetual,  so-called, 
277-278. 

Sitieirgia,  229. 

Sitiophobia,  229. 

Sleep,  fits  of,  examined  as  an  ac- 
cident of  hysteria,  104-109. 

Smell,  disturbances  of  sense  of,  183. 

Snellen,  letters  of,  for  eye-testing, 
190. 

Sollier,  219,  236. 

Somnambulisms,  definition  of,  24; 
illustrative  cases  of  monoideic, 
26-32;  characteristics  of,  32-37; 
analogy  between  fugues  and,  54- 
59;  differences  between  fugues 
and,  59-61 ;  polyideic,  61 ;  illus- 
trative cases,  61-64;  emancipa- 
tion of  feelings  and  emotions  in, 
64-65;  reciprocal,  72-74;  cases 
of,  74-77;  dominating,  77,  81- 
82;  complex  (double  and  re- 
ciprocal), 83;  analogy  between 
convulsive  attacks  and,  95-96; 
connection  between  fits  of  sleep 
and,  104-109;  artificial,  or  hyp- 
notism, 110-115. 

Spasms  of  jaws,  cheeks,  and  of 
pharynx,  265. 

Speech,  troubles  of,  208  ff . ;  tics  of, 
224-225;  automatic,  225;  eman- 
cipation of  function  of,  226. 

Spitting,  tics  of,  265. 

Stammering,  217. 

Stigmata,  problem  of,  271  ff.;  divi- 
sion into  proper  and  common, 
294;  the  common,  311-312. 

Strabismus,  206. 

Strumpell,  definition  of  hysteria  by, 

325- 

Subconsciousness,  phenomenon  of, 
296-297. 


Suggestibility,  270  ff. ;  the  most 
important  mental  stigma  of  hys- 
teria, 292. 

Suggestion,  mental  phenomenon 
of,  279  ff. ;  distinct  meaning  of, 
279>  33°  >  description  of  principal 
facts  of,  279-281;  difference  be- 
tween normal  phenomena  and, 
283-285;  the  conditions  of,  285- 
286. 

Swelling  of  abdomen,  263-264. 

Sydenham,  14,  18,  151,  271;  chorea 
of,  123. 

T 

Taine,  on  double  personality,  78. 

Tardieu,  277. 

Taste,  disturbances  of  sense  of,  183. 

Tics,  119-123;  characteristics  of, 
123-128;  hysteric  anesthesia  in, 
124-126;  of  speech,  224-225;  of 
inspiration,  259;  expiratory,  260- 
264;  complex  phenomena  of,  262- 
264;  of  perpetual  spitting  and 
salivation,  265 ;  of  eructation,  266. 

Todd,  study  of  traumatic  neuroses 
by,  140. 

Touch,  disturbances  of  sense  of, 
182-183. 

Tourette,  Gilles  de  la,  4,  199,  224, 
237;  work  of,  cited,  248. 

Tours,  Moreau  de,  7. 

Transfers,  298-300. 

Tremors,  phenomenon  of,  in  hys- 
teria, 129-131. 


Unity,  need  of,  under  diversity 
of  hysterical  phenomena,  270- 
272. 

V 

Vascular  reflexes,  160. 

Villermay,  Louyer  de,  15,  151. 

Vision,  troubles  of,  185  ff.,  339; 
dissociation  of  monocular  and 
binocular,  193-195;  narrowing 
of  the  visual  field,  195-201; 
disturbances  in  movements  of  the 
eyes,  205-207. 


Index 


345 


Vivet,  Louis,  case  illustrating  com- 
plex somnambulisms,  83-84. 

Voice,  troubles  with.     See  Speech. 

Voisin,  Jules,  83,  165. 

Vomiting,  hysterical,  266-268,  301, 
325,  336;  of  blood,  268-269. 

W 

Walks,  helicopode  and  helcopode, 
146,  174. 


Wallet,  Dr.,  article  by,  239-240,  241 
Walton,  Dr.  G.  L.,  184. 
Watson,  English  surgeon,  210. 
Will,  disturbances  of  the,  314-315. 
Witt,  14. 

Word-blindness,  219. 
Word-deafness,  219-2*1. 


Yawn,  the  hysterical,  259. 


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